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Impact of Age on Outcomes with Immunotherapy in Patients with Non-Small Cell Lung Cancer

Morgan R L Lichtenstein1, Ryan D Nipp1, Alona Muzikansky1

  • 1Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.

Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer
|November 27, 2018
PubMed
Abstract

Insights

Programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) blockade immunotherapy shows varying overall survival (OS) and progression-free survival (PFS) benefits across different age groups in NSCLC patients. However, immunotherapy-related toxicities remain consistent regardless of patient age.

Area of Science:

  • Oncology
  • Immunology
  • Clinical Medicine

Background:

  • Immunotherapy, particularly programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) blockade, has transformed non-small cell lung cancer (NSCLC) treatment.
  • Limited data exists on the efficacy and safety of PD-1/PD-L1 blockade across diverse age demographics in NSCLC patients.

Purpose of the Study:

  • To investigate the activity of programmed cell death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors in non-small cell lung cancer (NSCLC) patients across different age groups.
  • To compare progression-free survival (PFS), overall survival (OS), and treatment-related toxicities in various age cohorts receiving PD-1/PD-L1 blockade therapy.

Main Methods:

  • Retrospective analysis of 245 non-small cell lung cancer (NSCLC) patients who initiated programmed cell death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors between January 2013 and July 2017.
  • Evaluation of medical records and radiographic imaging to determine progression-free survival (PFS) and overall survival (OS).
  • Comparison of immunotherapy-related toxicities, steroid use, and hospitalization rates across age groups.

Main Results:

  • Median progression-free survival (PFS) varied by age group, with patients aged 70-79 showing the longest PFS (3.75 months) and those 80+ the shortest (1.64 months); overall significance (p=0.055).
  • Median overall survival (OS) was significantly different across age groups (p=0.011), with patients younger than 60 years surviving 13.01 months and those 80+ surviving only 3.62 months.
  • Rates of immunotherapy-related toxicities, steroid use, and hospitalizations were comparable across all evaluated age groups.

Conclusions:

  • While the overall survival (OS) and progression-free survival (PFS) benefits of immunotherapy for non-small cell lung cancer (NSCLC) differ among age groups, the incidence of treatment-related toxicities remains consistent.
  • These findings highlight the importance of considering age-related differences in treatment outcomes for NSCLC patients receiving PD-1/PD-L1 blockade therapy, while reassuringly indicating similar safety profiles across age demographics.
Keywords:
ImmunotherapyImmunotherapy-related adverse eventsNon–small cell lung cancerOlder adults

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