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Benefit of immunotherapy (IT) in advanced Non-Small Cell Lung Cancer (NSCLC) in Elderly patients (EP)

Date

10 Apr 2019

Presenters

Elena Corral de la Fuente

Citation

Annals of Oncology (2019) 30 (suppl_2): ii38-ii68. 10.1093/annonc/mdz063

Authors

E. Corral de la Fuente1, A. Barquín García2, C. Saavedra Serrano3, M.E. Olmedo García4, R. Martin Huertas5, J.J. Serrano Domingo2, V. Albarrán Artahona2, A. Gómez Rueda4

Author affiliations

  • 1 Oncology, Hospital Universitario Ramon y Cajal, 28031 - Madrid/ES
  • 2 Hospital Universitario Ramon y Cajal, Madrid/ES
  • 3 Medical Oncology, Hospital Universitario Ramon y Cajal, 28031 - Madrid/ES
  • 4 Medical Oncology, Hospital Universitario Ramon y Cajal, 28034 - Madrid/ES
  • 5 Hospital Universitario Ramon y Cajal, 28031 - Madrid/ES
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Background

Despite EP (aged ≥70 years) represent the majority of patients with advanced NSCLC, the efficacy and toxicity rates of IT remain poorly described, as they are under-represented in clinical trials. Furthermore, the age-related decline in the immune system might affect efficacy of IT.

Methods

We retrospectively reviewed advanced NSCLC patients treated with IT (antiPD-1, anti-PD-L1) monotherapy as first, second and subsequent-line settings, between 2014 and 2018 in our hospital. Patient and tumor features, irAEs, concomitant and subsequent treatments were collected. Stata 14.1 was used for the analysis.

Results

98 patients were included. Mean age was 62 years (41-85). 73.5% were men. 73.5% had >30 smoked pack-years (py), 64.3% were adenocarcinoma (ADC), of which 41% were KRAS mutated; and 25.5% were squamous (SCC). PDL1 was known in a 50% of patients (11% <1%, 13% 1-49%, 25% >50%). IT was administered mainly as a second line (61%) and third or later (24.5%). Most employed drug was nivolumab (52%) (Table). Response Rate (RR) was 32.7% (partial response 28%, complete response 5%). Disease control rate (DCR) was 55%. Overall Survival (OS) was significantly lower in EP compared to patients aged <70 years (5.5 vs 13 months (m) HR 3.86; IC 2.073- 7.214; P < 0.0001). Progression-free survival (PFS) was significantly worse for EP than for younger patients (1.8 vs 3.6m, HR 2.1; IC 1.181 - 3.744; P = 0.012). Regarding toxicity, 30.6% irAEs were reported. There were no statistically significant differences in terms of irAEs between EP and younger patients (P = 0.535). The development of irAEs was associated with better PFS in younger patients (13.3 vs 5.5m, HR 0.45; IC 0.244 - 0.840; P = 0.012) without significant impact on OS.

Conclusions

Our results suggest that EP could have worse survival outcomes than younger patients, without differences in terms of toxicity, but prospective trials are needed to confirm this hypothesis.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Elena Corral de la Fuente.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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