Park Ji Eun, Hong Kyung Soo, Choi Sun Ha, Lee Shin Yup, Shin Kyeong-Cheol, Jang Jong Geol, Kwon Yong Shik, Park Sun Hyo, Choi Keum-Ju, Jung Chi Young, Eom Jung Seop, Kim Saerom, Seol Hee Yun, Kim Jehun, Kim Insu, Park Jin Han, Kim Tae Hoon, Ahn June Hong
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Clin Lung Cancer. 2024 Jun;25(4):354-364. doi: 10.1016/j.cllc.2024.02.006. Epub 2024 Feb 17.
The PACIFIC trial demonstrated survival benefit of durvalumab after concurrent chemoradiotherapy (CCRT) in unresectable stage III non-small-cell lung cancer. Data on the effectiveness and safety of durvalumab in elderly patients is lacking.
This retrospective study was conducted between September 2017 and September 2022. Progression-free survival (PFS), overall survival (OS), recurrence patterns, first subsequent treatment after recurrence, factors associated with survival outcomes, and adverse events (AEs) were compared.
Of the 286 patients, 120 (42.0%) were ≥ 70 years and 166 (58.0%) were < 70 years. The median PFS (17.7 vs. 19.4 months; P = .43) and median OS (35.7 months vs. not reached; P = .13) were similar between 2 groups. Proportion of patients who completed durvalumab was lower in elderly patients (27.5% vs. 39.2%; P = .040). In elderly patients, ECOG PS 0 or 1 was associated with better PFS, and being male and having received a cisplatin-based regimen during CCRT were factors associated with better and worse OS, respectively. In patients aged < 70 years, a PD-L1 ≥ 50% was associated with improved PFS and OS. Elderly patients experienced more treatment-related AEs, grade 3/4 AEs, permanent discontinuation of durvalumab, and treatment-related deaths. Among the AEs leading to permanent discontinuation or death, pulmonary AE was significantly more common in elderly patients.
Durvalumab demonstrated similar outcomes in elderly compared to younger patients. However, AEs were more common in elderly patients. Thus, judicious selection of patients and chemotherapy regimens, coupled with careful AE monitoring, are important factors for ensuring optimal durvalumab treatment.
PACIFIC试验证明了度伐利尤单抗在不可切除的III期非小细胞肺癌同步放化疗（CCRT）后具有生存获益。目前缺乏度伐利尤单抗在老年患者中的有效性和安全性数据。
本回顾性研究于2017年9月至2022年9月进行。比较了无进展生存期（PFS）、总生存期（OS）、复发模式、复发后的首次后续治疗、与生存结果相关的因素以及不良事件（AE）。
286例患者中，120例（42.0%）年龄≥70岁，166例（58.0%）年龄<70岁。两组的中位PFS（17.7个月对19.4个月；P = 0.43）和中位OS（35.7个月对未达到；P = 0.13）相似。老年患者完成度伐利尤单抗治疗的比例较低（27.5%对39.2%；P = 0.040）。在老年患者中，东部肿瘤协作组（ECOG）体能状态（PS）为0或1与更好的PFS相关，男性以及在CCRT期间接受基于顺铂的方案分别与更好和更差的OS相关。在年龄<70岁的患者中，程序性死亡受体1配体（PD-L1）≥50%与PFS和OS改善相关。老年患者经历了更多与治疗相关的AE、3/4级AE、度伐利尤单抗的永久停药以及与治疗相关的死亡。在导致永久停药或死亡的AE中，肺部AE在老年患者中明显更常见。
与年轻患者相比，度伐利尤单抗在老年患者中显示出相似的结果。然而，AE在老年患者中更常见。因此，明智地选择患者和化疗方案，以及仔细监测AE，是确保度伐利尤单抗治疗达到最佳效果的重要因素。
