Immune Checkpoint Inhibitor Therapy Alone Is Effective in Older Adults With Advanced NSCLC

Immune checkpoint inhibitor (ICI) therapy alone may be recommended for older adults with previously untreated advanced non-small cell lung cancer (NSCLC), according to a study published in JAMA Oncology.

“[ICI] plus chemotherapy combination treatment (ICI-chemotherapy) is now a standard treatment for [NSCLC] without targetable oncogene alterations, but there are few data on ICI-chemotherapy for patients 75 years and older,” the researchers said.

In their retrospective cohort study, researchers evaluated 1245 patients 75 years of age and older with clinical stage IIIB, IIIC, IV, postoperative, or radiotherapy recurrent NSCLC. Patients in the population of interest started first-line systemic therapy between December 2018 and March 2021. The main end points were defined as overall survival (OS), progression-free survival (PFS), and safety.

The results showed that PD-L1 expression <1% occurred in 22% of tumors, PD-L1 expression of 1% to 49% in 31%, PD-L1 expression of ≥50% in 33%, and unknown PD-L1 expression in 14%. The researchers noted that for PD-L1 expression of 1% and higher, the OS hazard ratio (HR) was 0.98 (95% CI, 0.67-1.42; P=.90), and the PFS HR was 0.92 (95% CI, 0.67-1.25; P=.59). Significance was not reached when separately analyzed for lower or higher PD-L1 expression (1%-49% or ≥50%). However, grade 3 or higher immune-related adverse events (AEs) occurred in 86 patients (24.3%) treated with ICI-chemotherapy and 76 (17.9%) treated with ICI alone (P=.03).

“In this study, ICI-chemotherapy combination treatment did not improve survival and increased the incidence of grade 3 and higher immune-related [AEs] compared with ICI alone in patients 75 years and older. Based on these results, ICI alone may be recommended for older adult patients with PD-L1–positive NSCLC,” the researchers concluded.