Fukushima Takahiro, Oyamada Yoshitaka, Ikemura Shinnosuke, Nukaga Shigenari, Inoue Takashi, Arai Daisuke, Ohgino Keiko, Kuroda Aoi, Ishioka Kota, Sakamaki Fumio, Suzuki Yusuke, Terai Hideki, Yasuda Hiroyuki, Kawada Ichiro, Fukunaga Koichi, Soejima Kenzo
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan.
Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan.
Clin Lung Cancer. 2022 Sep;23(6):532-541. doi: 10.1016/j.cllc.2022.05.003. Epub 2022 May 11.
The optimal treatment for advanced non-small cell lung cancer (NSCLC) in very elderly patients is unclear. We aimed to evaluate their treatment in real-world clinical practice and identify suitable therapy that can improve their prognosis.
The medical records of 132 Japanese patients aged 80 years and older with advanced NSCLCs who were enrolled at a university hospital and its 9 affiliates were retrospectively analyzed. Clinical characteristics and overall survival (OS) were compared based on the Eastern Cooperative Oncology Group Performance Status (ECOG PS) and biomarker statuses. Patients were defined as biomarker-positive if programmed death-ligand 1 tumor proportion score (PD-L1 TPS) was ≥ 50% or activating mutations were present in epidermal growth factor receptor, anaplastic lymphoma kinase, or c-ros oncogene 1. Finally, the factors contributing to better prognosis were explored in both PS 0 - 2 and PS 3 - 4 patient groups.
The PS 0 - 2 patients showed a longer median OS than the PS 3 - 4 patients (5.5 vs. 1.6 months). PS 0 - 2 patients with positive biomarkers who received chemotherapy showed a significantly longer median OS than those without (18.1 vs. 3.7 months). Among the biomarker-negative/unknown PS 0 - 2 patients, the median OS showed no significant difference between those who received chemotherapy and those who did not (4.5 vs. 3.1 months). The multivariate analysis showed that treatment with tyrosine kinase inhibitors or immune checkpoint inhibitors was related to better prognoses in the PS 0 - 2 group.
Biomarker-matched therapy is effective even in very elderly patients. Meanwhile, the effectiveness of chemotherapy for biomarker-negative/unknown PS 0 - 2 patients is questionable.
高龄晚期非小细胞肺癌（NSCLC）患者的最佳治疗方案尚不清楚。我们旨在评估其在真实世界临床实践中的治疗情况，并确定可改善其预后的合适治疗方法。
回顾性分析了一所大学医院及其9家附属医院收治的132例年龄≥80岁的晚期NSCLC日本患者的病历。根据东部肿瘤协作组体能状态（ECOG PS）和生物标志物状态比较临床特征和总生存期（OS）。如果程序性死亡配体1肿瘤比例评分（PD-L1 TPS）≥50%或表皮生长因子受体、间变性淋巴瘤激酶或c-ros原癌基因1存在激活突变，则将患者定义为生物标志物阳性。最后，在PS 0-至2和PS 3至4患者组中探索有助于改善预后的因素。
PS 0至2患者的中位OS长于PS 3至4患者（5.5个月对1.6个月）。接受化疗的生物标志物阳性的PS 0至2患者的中位OS显著长于未接受化疗的患者（18.1个月对3.7个月）。在生物标志物阴性/未知的PS 0至2患者中，接受化疗和未接受化疗的患者中位OS无显著差异（4.5个月对3.1个月）。多变量分析显示，酪氨酸激酶抑制剂或免疫检查点抑制剂治疗与PS 0至2组更好的预后相关。
生物标志物匹配治疗即使在高龄患者中也有效。同时，化疗对生物标志物阴性/未知的PS 0至2患者的有效性值得怀疑。
