1224P - Evaluation of safety and feasibility of adjuvant chemotherapy in elderly patients with primary non-small cell lung cancer

Background

Lung cancer remains the leading cause of cancer-related death worldwide. In selected cases, treatment of resected Non-Small Cell Lung Cancer (NSCLC) requires in adjuvant chemotherapy. However, no guidelines are available for adjuvant chemotherapy in patients over 75 years-old by lack of dedicated studies. In this study, we assessed the benefit of adjuvant chemotherapy in patients over 75 years-old with NSCLC.

Methods

We conducted a single centre retrospective study in Marseille University Hospital based on the prospective EPITHOR database, including all patients over 75 years-old with NSCLC who underwent a complete lung anatomical surgical resection, with a theorical indication for adjuvant chemotherapy between January 2013 and July 2022. We compared survival outcomes of patients undergoing adjuvant chemotherapy or not. Primary outcome was 5 years disease-free survival (DFS) (Fine and Gray model, 5-years relapse rate being the competitive event) and secondary objectives was overall survival.

Results

129 patients were eligible for our study, 36 in the adjuvant chemotherapy group and 93 in the control group. Patients treated with adjuvant chemotherapy appeared to be younger, have a favourable perioperative course and a positive post-operative lymph node status. Adjuvant chemotherapy was significantly related to 5-years DFS in univariate analysis (HR=0.257 [95% CI: 0.080-0.819] p=0.0216) but not in multivariate analysis (HR=0.641 [95% CI: 0.144-1.473] p=0.191).Adjuvant chemotherapy was related to a lower mortality in univariate analysis (HR=0.567 [95% CI: 0.312-1.031] p=0.0631) but in multivariate analysis, chemotherapy did not seem to be related with cancer relapse or death (HR = 1.284 [95% CI: 0.72-2.28], p=0.40). Multivariate model included comorbidity index, age and VEMS.

Conclusions

Within daily care, oncologists tend to propose adjuvant chemotherapy on a patient-by-patient basis according to their post-operative lymph node status and comorbidities. This study provides a scientific basis for these choices and suggests that adjuvant chemotherapy benefit must be balanced considering specific geriatric comorbidities. Further studies will be needed to set up dedicated guidelines.

Clinical trial identification

PADS23-151.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

A. Mogenet: Financial Interests, Institutional, Advisory Board: Pfizer, Takeda, AstraZeneca; Financial Interests, Institutional, Other, Travel fee: BMS; Financial Interests, Institutional, Invited Speaker: Takeda, Viatris. A. Couderc: Financial Interests, Institutional, Speaker, Consultant, Advisor: BMS, Ferrring, Nutricia, Amgen, Sanofi, GSK. P. Tomasini: Financial Interests, Personal, Invited Speaker: Roche, AstraZeneca, BMS, Lilly, Janssen, Amgen, Takeda; Financial Interests, Institutional, Local PI: Roche, AstraZeneca, Amgen, Lilly, Takeda; Financial Interests, Institutional, Coordinating PI: Janssen. L. Greillier: Financial Interests, Personal, Advisory Board: AbbVie, AstraZeneca, BMS, MSD, Novartis, Sanofi, Takeda, Roche; Financial Interests, Personal, Invited Speaker: Lilly, Pfizer; Financial Interests, Institutional, Local PI: AstraZeneca, AbbVie, BMS, MSD, Novartis, Takeda, Pfizer, Roche, PharmaMar; Financial Interests, Institutional, Coordinating PI: Sanofi. J. Pluvy: Financial Interests, Personal, Invited Speaker: Sanofi, Roche, Takeda, AstraZeneca, Viatris; Financial Interests, Personal, Advisory Board: Takeda, Sanofi. P.A. Thomas: Financial Interests, Institutional, Speaker, Consultant, Advisor: AstraZeneca, BMS, Roche, MSD, Amgen; Financial Interests, Institutional, Advisory Board: Ethicon. All other authors have declared no conflicts of interest.