Do Elderly Lung Cancer Patients Aged ≥75 Years Benefit from Immune Checkpoint Inhibitors?

Abstract

Lung cancer patients ≥75 years represent nearly 40% of all lung cancer patients and continue to increase. If elderly patients have a good performance status and adequate organ function, they can be treated the same as non-elderly patients. However, few comparative studies limited to elderly patients (≥75 years) have been conducted. We review the evidence on using immune check inhibitors for the treatment of elderly patients (≥75 years old) with advanced non-small cell lung cancer. Prospective randomized or non-randomized, retrospective, registrational, insurance-based, and community-based studies have shown that elderly (≥75 years) and non-elderly patients are similarly treated with immune check inhibitors effectively and safely. However, such analyses have not shown that immune check inhibitors are significantly more effective than chemotherapy alone. In addition, patient selection might be critically performed to administer immune check inhibitors in the elderly because they are more likely to have a poor performance status with comorbidities, which lead to little benefit, even in non-elderly patients. There is a need for more evidence showing the benefit of immune check inhibitors in non-small cell lung cancer patients ≥75 years.

Keywords: elderly; immune checkpoint inhibitor; lung cancer.

Figure 1

The meta-analysis was conducted using a random effects model, which weighed studies using the restricted maximum likelihood method. Studies were combined by pooling the hazard ratios (log scale) and corresponding standard errors. No significant difference was observed between immune checkpoint inhibitor therapy and chemotherapy (a). Funnel plots of the six studies revealed little publication bias (b). The package ‘metafor’ in the R Statistical Platform, v3.5.1 (R Foundation, Vienna, Austria), was used for the analysis.