Mao Yunye, Sheng Shu, Wang An, Zhai Jinzhao, Ge Xiangwei, Lu Di, Wang Jinliang
Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China.
Chinese PLA Medical School, Beijing 100853, China.
Zhongguo Fei Ai Za Zhi. 2024 May 20;27(5):367-375. doi: 10.3779/j.issn.1009-3419.2024.106.10.
The incidence of cancer is closely correlated with age, as 75% of non-small cell lung cancer (NSCLC) patients are aged at least 65 years. The availability of immune checkpoint inhibitors (ICIs) has altered the available NSCLC therapeutic pattern. Limited studies on elderly patients have demonstrated that ICIs as monotherapy provide substantial benefits for patients aged 65-75 years, showing no significant difference compared to younger patients. This benefit is also observed in combination with immune-combined chemotherapy or radiotherapy. For individuals older than 75 years, the survival effect was not evident, though. Immune-related adverse events (irAEs) with ICIs alone were similar in incidence across age categories. Immune-combination chemotherapy resulted in a higher incidence of irAEs than chemotherapy alone, and patients ≥75 years of age were more likely to experience higher-grade irAEs. Besides the fact that immunosenescence in older patients influences the immune milieu in a multifaceted manner, which in turn impacts the effectiveness of immunotherapy, the prognosis is also influenced by the Eastern Cooperative Oncology Group performance status (ECOG PS) score, among other factors. For certain individuals aged ≥75 years or in poor physical health, immunotherapy combined with low-intensity chemotherapy has emerged as a viable treatment option. However, there are fewer related studies, so there should be a conscious effort to increase the number of elderly patients enrolled in the trial and a comprehensive assessment to explore individualized treatment options. To provide additional references and guidance for immunotherapy in elderly NSCLC patients and to propose new therapeutic perspectives in combination with their characteristics, this review aims to summarize and analyze the pertinent studies on the application of programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors in these patients. .
癌症发病率与年龄密切相关，因为75%的非小细胞肺癌（NSCLC）患者年龄至少为65岁。免疫检查点抑制剂（ICI）的出现改变了NSCLC的现有治疗模式。针对老年患者的有限研究表明，ICI作为单一疗法可为65至75岁的患者带来显著益处，与年轻患者相比无显著差异。在免疫联合化疗或放疗中也观察到了这种益处。然而，对于75岁以上的个体，生存效果并不明显。单独使用ICI时，免疫相关不良事件（irAE）的发生率在各年龄组中相似。免疫联合化疗导致irAE的发生率高于单纯化疗，且75岁及以上的患者更有可能发生更高级别的irAE。除了老年患者的免疫衰老以多方面方式影响免疫环境，进而影响免疫治疗效果外，预后还受到东部肿瘤协作组体能状态（ECOG PS）评分等因素的影响。对于某些年龄≥75岁或身体健康状况较差的个体，免疫治疗联合低强度化疗已成为一种可行的治疗选择。然而，相关研究较少，因此应有意识地增加纳入试验的老年患者数量，并进行全面评估以探索个体化治疗方案。为了为老年NSCLC患者的免疫治疗提供更多参考和指导，并结合其特点提出新的治疗观点，本综述旨在总结和分析关于程序性细胞死亡蛋白1（PD-1）/程序性细胞死亡配体1（PD-L1）抑制剂在这些患者中应用的相关研究。
