Piotr Wysocki, Professor of Medicine and Head of the Department of Oncology at Jagiellonian University Hospital, shared on LinkedIn:

“Tsukita Y et al. conducted a retrospective analysis of 1245 patients (75 years of age or older) diagnosed with stage IIIB-IV non-small cell lung cancer (NSCLC) who received first-line systemic treatment. PD-L1 expression <1% was detected in 22% of tumors, 1%-49% in 31%, and 50% or higher in 33%, while 14% of cases had unknown PD-L1 status. The authors compared outcomes of patients treated with chemoimmunotherapy, single-agent immunotherapy, platinum-based chemotherapy doublet, and single-agent chemotherapy.

After a median follow-up of 19.2, the median OS was:

• 20.0 months in the chemoimmunotherapy group
• 9.8 months in the single-agent immunotherapy group
• 12.8 months in the platinum-doublet chemotherapy group
• 9.5 months in a single-agent chemotherapy group

The median PFS was:

• 7.7 months in chemoimmunotherapy group
• 7.7 months in single-agent immunotherapy group
• 5.4 months in the platinum-doublet chemotherapy group
• 3.4 months in single-agent chemotherapy group

The analysis demonstrated that in elderly patients, there were no significant differences between single-agent immunotherapy (A) and chemoimmunotherapy (B), regardless of histology or PD-L1 expression:

• Adenocarcinoma – OS: 26.2 months (A) vs 20.4 months (B) – HR, 1.03; 95% CI, 0.78-1.37
• Squamous-cell cancer – OS: 18.3 months (A) vs 13.8 months (B) – HR,0.79; 95%CI,0.57-1.09
• PD-L1 1%-49% – OS: OS: 19.0 months (A) vs 14.5 months (B) – HR, 1.11; 95% CI, 0.65-1.91 PD-L1 >50% – OS: 26.2 months (A) vs 28 months (B) – HR, 0.92; 95% CI, 0.55-1.56

The study of Tsukita Y et al. clearly demonstrates that elderly, fragile, advanced NSCLC patients do not benefit from aggressive systemic treatment based on a combination of chemotherapy and checkpoint inhibitors. Such a population should be offered single-agent immunotherapy.

In my clinical practice in elderly NSCLC patients, I consider using chemoimmunotherapy only in individuals presenting with severe symptoms or imminent visceral crisis in whom I use weekly regimens based on a combination of cisplatin (usually 25 mg/m2) or carboplatin (AUC2) + (metronomic vinorelbine [30-40 mg p.o. bid], or weekly paclitaxel [80 mg/m2], or weekly pemetrexed [175 mg/m2]).”

Source: Piotr Wysocki/LinkedIn

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