Department of Medical Oncology, BC Cancer - Vancouver Centre, 600 10th Avenue West, Vancouver, BC, V5Z 4E6, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
BMC Cancer. 2023 Apr 19;23(1):360. doi: 10.1186/s12885-023-10800-x.
Over the past decade, there has been increasing availability of novel therapeutics with improved tolerability and efficacy for advanced non-small cell lung cancer (NSCLC). The study goals were: to compare the uptake of systemic therapy (ST) before and after the availability of targeted tyrosine kinase inhibitors (TKI) and immunotherapy and to examine the changes in overall survival (OS) over time between younger and older adults with advanced NSCLC.
All patients with advanced NSCLC referred to British Columbia (BC) Cancer in 2009, 2011, 2015 and 2017 were included. One-year time points were based on molecular testing implementation and funded drug availability: baseline (2009), epidermal growth factor receptor TKI (2011), anaplastic lymphoma kinase TKI (2015) and Programed Death-1 (PD-1) inhibitors (2017). Age groups were <70years and ≥70years. Baseline demographics, simplified comorbidity scores (SCS), disease characteristics, and ST details were collected retrospectively. Variables were compared using X2, Fisher's exact tests and logistic-regression analysis. OS was calculated using the Kaplan-Meier method and compared using the log-rank test.
3325 patients were identified. Baseline characteristics were compared between ages < 70 years and ≥ 70 years for each time cohort with significant differences noted in baseline Eastern Cooperative Oncology Group (ECOG) performance status and SCS. The rate of ST delivery trended upwards over time with age <70 years: 2009 44%, 2011 53%, 2015 50% and 2017 52% and age ≥70 years: 22%, 25%, 28% and 29% respectively. Predictors for decreased use of ST for age <70 years: ECOG ≥2, SCS ≥9, year 2011, and smoking history; and age ≥70 years: ECOG ≥2, years 2011 and 2015, and smoking history. The median OS of patients who received ST improved from 2009 to 2017: age <70 years 9.1 m vs. 15.5 m and age ≥70 years 11.4 m vs. 15.0 m.
There was an increased uptake of ST for both age groups with the introduction of novel therapeutics. Although a smaller proportion of older adults received ST, those who received treatment had comparable OS to their young counterpart. The benefit of ST in both age groups was seen across the different types of treatments. With careful assessment and selection of appropriate candidates, older adults with advanced NSCLC appear to benefit from ST.
在过去的十年中，针对晚期非小细胞肺癌（NSCLC）的新型治疗药物的耐受性和疗效得到了改善，因此其应用也越来越广泛。本研究旨在比较靶向酪氨酸激酶抑制剂（TKI）和免疫治疗出现前后系统治疗（ST）的应用情况，并分析不同年龄段晚期 NSCLC 患者的总生存期（OS）随时间的变化情况。
所有于 2009 年、2011 年、2015 年和 2017 年在不列颠哥伦比亚省癌症中心（BC Cancer）就诊的晚期 NSCLC 患者均被纳入研究。一年的时间点基于分子检测的实施和已获得资金支持的药物的可用性：基线（2009 年）、表皮生长因子受体 TKI（2011 年）、间变性淋巴瘤激酶 TKI（2015 年）和程序性死亡受体-1（PD-1）抑制剂（2017 年）。年龄组分为<70 岁和≥70 岁。回顾性收集患者的基线人口统计学数据、简化合并症评分（SCS）、疾病特征和 ST 细节。使用 X2、Fisher 精确检验和逻辑回归分析比较变量。采用 Kaplan-Meier 法计算 OS，并采用对数秩检验比较。
共纳入 3325 例患者。根据每个时间队列中<70 岁和≥70 岁的年龄对患者的基线特征进行比较，在基线东部肿瘤协作组（ECOG）表现状态和 SCS 方面存在显著差异。随着时间的推移，<70 岁患者接受 ST 的比例呈上升趋势：2009 年为 44%，2011 年为 53%，2015 年为 50%，2017 年为 52%；而≥70 岁患者的比例分别为 22%、25%、28%和 29%。<70 岁患者 ST 使用率下降的预测因素为 ECOG 评分≥2、SCS≥9、2011 年和吸烟史；≥70 岁患者的预测因素为 ECOG 评分≥2、2011 年和 2015 年以及吸烟史。接受 ST 治疗的患者 OS 从中位数来看，<70 岁患者从 2009 年的 9.1 个月延长至 2017 年的 15.5 个月，而≥70 岁患者从 11.4 个月延长至 15.0 个月。
新型治疗药物的出现增加了两个年龄组对 ST 的应用。尽管接受 ST 的老年患者比例较小，但接受治疗的患者与年轻患者的 OS 相当。两个年龄组的患者均从不同类型的治疗中获益。对于晚期 NSCLC 老年患者，在仔细评估和选择合适的患者后，ST 似乎可带来获益。
