515P - Polypharmacy as a prognostic factor in elderly patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors

Background

Polypharmacy (PP) is a common problem in elderly patient population. However, the prevalence and impact of PP on treatment-related morbidities in elderly patients with advanced cancer have not been well investigated.

Methods

We retrospectively analyzed data from 157 elderly (aged ≥65 years) patients treated with immune checkpoint inhibitor (ICI) for advanced or recurrent non-small cell lung cancer (NSCLC). Statistical analysis was performed using the Kaplan–Meier method and Cox regression adjusted for risk factors.

Results

The prevalence of PP, defined as ≥ 5 medications, was 40.1% (63/157). The prevalence of potentially inappropriate medication (PIM), according to the screening tool of older people’s prescription (STOPP) criteria version 2, was 38.2% (60/157). The median progression-free survival (PFS) times in patients with and without PP were 3.7 [95% confidence interval (CI), 1.8–5.4] and 5.5 (95% CI, 3.4–9.0) months, respectively (P = 0.0017). The median overall survival (OS) times in patients with and without PP were 9.5 (95% CI, 6.0–14) and 28.1 (95% CI, 13.3–not reached) months, respectively (P < 0.001). Multivariate analysis revealed marked associations between PP and OS, but no significant associations between PP and PFS. PP was not associated with immune-related adverse events (irAE) but was associated with increased unexpected hospitalizations during ICI treatment.

Conclusions

PP is an independent prognostic factor in elderly patients with advanced or recurrent NSCLC treated with ICI. Although PP may not affect the efficacy or toxicity of ICI, it is useful as a simple surrogate indicator of comorbidities or as a predictive marker of negative events during ICI treatment.

Clinical trial identification

Editorial acknowledgement

The authors thank Enago for the English language review.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

Y. Hosomi: Speaker Bureau / Expert testimony: AstraZeneca; Speaker Bureau / Expert testimony: Chugai Pharmaceutical; Speaker Bureau / Expert testimony: Eli Lilly Japan; Speaker Bureau / Expert testimony: Ono Pharmaceutical; Speaker Bureau / Expert testimony: Taiho Pharmaceutical. All other authors have declared no conflicts of interest.