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Multicenter Study
. 2025 Jun;26(4):331-337.
doi: 10.1016/j.cllc.2025.03.001. Epub 2025 Mar 4.

First-Line Pembrolizumab Efficacy in Octogenarians With NSCLCs Expressing ≥ 50% PD-L1 (ESCKEYP GFPC 05-2018)

Romain Corre  1 , Chantal Decroisette  2 , Jean-Bernard Auliac  3 , Lionel Falchero  4 , Hubert Curcio  5 , Karim Amrane  6 , Maurice Perol  2 , Stéphane Hominal  7 , Sabine Vieillot  8 , Eric Huchot  9 , Anne Laure Desage  10 , Marie Bernardi  11 , Remi Veillon  12 , Hélène Doubre  13 , Suzanna Bota  14 , Gwenaelle Legarff  15 , Grégoire Justeau  16 , Oliver Bylicki  17 , Magali Roa  18 , Renaud Descourt  19 , Christos Chouaïd  20 , Laurent Greillier  21
Affiliations
Multicenter Study

First-Line Pembrolizumab Efficacy in Octogenarians With NSCLCs Expressing ≥ 50% PD-L1 (ESCKEYP GFPC 05-2018)

Romain Corre et al. Clin Lung Cancer. 2025 Jun.

Abstract

Background: Pembrolizumab alone is a first-line therapeutic option for patients with metastatic non-small cell lung cancer (NSCLC) with ≥ 50% PD-L1 expression, but few data are available for elderly patients, specifically octogenarians.

Methods: This retrospective, multicenter study included all consecutive patients with metastatic NSCLC PD-L1 ≥ 50% treated with first-line pembrolizumab monotherapy between May 2017 and November 2019. Information was collected from medical files with local evaluation of therapeutic response and progression-free survival (PFS).

Results: Among the 844 patients included, 73 (8.4%) were ≥ 80 (median: 82) years old, 74% men, 23.3% with ECOG-PS ≥ 2, 26% had ≥ 5% weight loss, PD-L1 50%-75%/≥ 75%: 45.2%/46.6%, respectively, with significantly more nonsmokers and (17.4% vs. 5.6%, P = .0002) and fewer adenocarcinomas (57.5% vs. 70.8%, P = .0217) than those < 80 years. After median follow-up of 45.7 (95% CI: 43.0-49.1) months, respective median overall survival (OS) for octogenarians versus younger patients lasted 12.0 (95% CI: 7.7-16.2) versus 23.9 (95% CI: 19.5-27.4) months (P = .0002), and median PFS for 5.0 (95% CI: 2.8-9.2) versus 8.3 (95% CI: 7.2-9.8) months (P = .039). Their respective objective response rates did not differ significantly: 42% (95% CI: 24-60) vs. 49% (95% CI: 43-54).

Conclusions: Based on the results of this large multicenter population, first-line pembrolizumab efficacy against NSCLCs expressing ≥ 50% PD-L1 in octogenarians seems inferior to that obtained in younger patients. The higher percentage of nonsmokers and fewer adenocarcinomas could partially explain that finding.

Keywords: Elderly; Immunotherapy; Lung cancer; Octogenarians; Senescence.

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Conflict of interest statement

Disclosure L Greillier reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, Bayer, and Amgen, outside the submitted work. C Chouaïd reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, GSK, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, Bayer, and Amgen, outside the submitted work. C Decroisette reports personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, and Amgen, outside the submitted work. M Pérol reports personal fees and nonfinancial support from Roche, Eli Lilly, Pfizer, Boehringer Ingelheim, Merck Sharp & Dohme, Bristol-Myers Squibb, Novartis, AstraZeneca, Takeda, Gritstone, Sanofi, GlaxoSmithKline, Amgen, Chugai, Illumina, Daïchi-Sankyo, and Abbvie outside the submitted work. R Descourt reports personal fees and nonfinancial support from AstraZeneca, Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Takeda, and Chugai, outside the submitted work.

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