1483P - Challenge of systemic first-line treatment of elderly lung cancer patients

Background

At the time of diagnosis the majority of the lung cancer (LC) patients (pts) are old and have comorbidities. These elderly pts are underrepresented in clinical trials and their therapy options are limited. For pts whose tumor expresses PD-L1 at a lower level (TPS <50% or ICS <10%) combined platinum-based chemo-/immunotherapy is the recommended first line therapy, but elderly pts are usually unfit to receive these therapies at the regular dosage. A single-agent immunotherapy might be effective in some cases, but is only approved for pts with high PD-L1 expressing tumors (TPS ≥50% or ICS ≥10%). Data about the efficacy and safety of therapy for elderly LC pts are very limited.

Methods

In our retrospective data analysis all pts older than 75 years with LC regardless of stage treated at a German certified LC center and primary LC diagnosis from 2017 until 2022 were included. Progression-free and overall survival, objective response rate, and adverse events (AEs) resulting in therapy discontinuation were assessed for pts with systemic therapy. Data of geriatric assessment and its influence on therapy were analysed.

Results

365 out of all 1.837 newly diagnosed LC pts from 2017 to 2022 were older than 75 years. Of these pts, 115 pts (31.5%) underwent primary surgery and 15 pts (4.1%) primary radiotherapy; 143 pts (39.2%) received only systemic treatment and 92 pts (25.2%) had best supportive care. 43 pts (11.8%) sufferered from small cell LC and 322 pts (88.2%) non-small cell LC. 99 pts with systemic therapy (69.2%) received combined chemo-/immunotherapy, 31 pts (21.7%) immunomonotherapy and 13 pts (9.1%) a small molecule inhibitor. 22 pts with systemic therapy (15.4%) had an ECOG performance status (PS) of 0, 80 pts (56 %) a PS of 1, 36 pts (25.1%) PS of 2 and 5 pts (3.5%) a PS of 3. All elderly pts with high PD-L1 expressing tumors received immunomonotherapy. 89 pts (90%) of 99 pts with chemo-/immunotherapy received platinum-based chemotherapy. Of these, 30 pts (30%) had to stop therapy prematurely due to AEs.

Conclusions

Many elderly pts received combined platinum-based chemo-/immunotherapy, but therapy was often prematurely stopped due to AEs. A quarter of the pts with systemic therapy had a PS of 2. Only few pts with a poor PS (2/3) were treated with monochemotherapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Konstantinos Ferentinos.

Funding

Has not received any funding.

Disclosure

D.C.C. Christoph: Financial Interests, Personal, Speaker, Consultant, Advisor: AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, MSD Merck, Sharp & Dohme, Novartis, Novocure, Pfizer, Roche, Sanofi, Takeda. All other authors have declared no conflicts of interest.