免疫检查点抑制剂在老年非小细胞肺癌患者中的疗效和安全性的真实世界数据。

Real-world data on the efficacy and safety of immune-checkpoint inhibitors in elderly patients with non-small cell lung cancer.

机构信息

Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Department of Respiratory Medicine, Sapporo Minami-Sanjo Hospital, Sapporo, Japan.

出版信息

Cancer Med. 2023 May;12(10):11525-11541. doi: 10.1002/cam4.5889. Epub 2023 Mar 31.

PURPOSE

Immune-checkpoint inhibitors (ICIs) are effective against advanced non-small cell lung cancer (NSCLC). However, whether the efficacy and safety of ICI treatment in elderly patients are similar to those in younger patients is unclear. This study was designed to address this question.

METHODS

We enrolled patients who received ICI monotherapy in Japan between December 2015 and December 2017; those ≥75 years of age comprised the elderly group. We compared the efficacy and safety of ICI monotherapy in elderly patients with those in younger patients and explored prognostic factors in elderly patients.

RESULTS

We enrolled 676 patients; 137 (20.3%) were assigned to the elderly group. The median age of the elderly and younger groups was 78 (range, 75-85) and 66 (range, 34-74) years. The median progression-free survival (4.8 months vs. 3.3 months, p = 0.1589) and median overall survival (12.3 months vs. 13.0 months, p = 0.5587) were similar between the elderly and younger groups. Multivariate analysis revealed that a significantly better OS in the elderly group was associated with better responses to first- or second-line ICI treatment (p = 0.011) and more immune-related adverse events (irAEs) (p = 0.02). IrAEs that led to ICI discontinuation occurred in 34 of 137 patients (24.8%) in the elderly group, and their survival was significantly higher than that in those who did not have irAEs.

CONCLUSION

ICI is also effective in elderly NSCLC patients, and treatment discontinuation due to irAEs may be a good prognostic marker.

目的

免疫检查点抑制剂（ICI）对晚期非小细胞肺癌（NSCLC）有效。然而，ICI 治疗在老年患者中的疗效和安全性是否与年轻患者相似尚不清楚。本研究旨在解决这一问题。

方法

我们纳入了 2015 年 12 月至 2017 年 12 月期间在日本接受 ICI 单药治疗的患者；年龄≥75 岁的患者归入老年组。我们比较了老年患者和年轻患者接受 ICI 单药治疗的疗效和安全性，并探讨了老年患者的预后因素。

结果

我们共纳入了 676 例患者；其中 137 例（20.3%）归入老年组。老年组和年轻组的中位年龄分别为 78（范围，75-85）岁和 66（范围，34-74）岁。老年组和年轻组的中位无进展生存期（4.8 个月 vs. 3.3 个月，p=0.1589）和中位总生存期（12.3 个月 vs. 13.0 个月，p=0.5587）相似。多因素分析显示，老年组的 OS 更好与对一线或二线 ICI 治疗的更好反应（p=0.011）和更多免疫相关不良事件（irAEs）（p=0.02）相关。在老年组的 137 例患者中，有 34 例（24.8%）发生了导致 ICI 停药的 irAEs，他们的生存明显高于没有 irAEs 的患者。