Division of Medical Oncology, A.O.R.N. San Giuseppe Moscati, Contrada Amoretta, Avellino, AV, Italy.
Expert Opin Emerg Drugs. 2023 Dec;28(2):121-127. doi: 10.1080/14728214.2023.2211346. Epub 2023 May 9.
Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) as the most common subtype. In the past decades, immunotherapy deeply changed paradigms for care of newly diagnosed advanced NSCLC patients without oncogenic driver mutations. An immunotherapy-based regimen alone or in combination to chemotherapy was crowned as the preferred option to choice, according to worldwide guideline.
Newly diagnoses of advanced NCSLC occurred predominantly in elderly patients, representing over half of patients treated in daily practice. However, data on older patients' treatments are still lacking, because they are under-represented in clinical trials. This leads to a 'black hole' of knowledge about efficacy and safety of immune-checkpoint inhibitors use in this cohort of population.
According to available data from subgroup analyses, immunotherapy as single agent seem to work in elderly similarly to younger patients, with no excess of toxicities. In contrast, the real impact - and not least the safety - of an immune-chemo combination use in elderly population was still unclear. Awaiting data from dedicated clinical trials, this review will discuss available results from randomized phase III clinical trials comparing immune-chemo combinations to chemotherapy alone, focusing on elderly subgroup enrolled.
肺癌是全球癌症相关死亡的主要原因，其中非小细胞肺癌（NSCLC）最为常见。在过去几十年中，免疫疗法彻底改变了对无致癌驱动突变的新诊断晚期 NSCLC 患者的治疗模式。根据全球指南，免疫疗法单独或联合化疗已成为首选方案。
新诊断的晚期 NSCLC 主要发生在老年患者中，占日常治疗患者的一半以上。然而，由于临床试验中代表性不足，老年患者治疗的数据仍然缺乏。这导致了该人群中免疫检查点抑制剂使用的疗效和安全性的“知识黑洞”。
根据亚组分析的现有数据，免疫单药治疗在老年患者中的效果与年轻患者相似，且毒性无增加。相比之下，免疫化疗联合治疗在老年人群中的实际影响——尤其是安全性——仍不清楚。在等待专门的临床试验数据的同时，本次综述将讨论比较免疫化疗联合与单独化疗的随机 III 期临床试验的现有结果，重点关注入组的老年亚组。
