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Age-related efficacy of immunotherapies in advanced non-small cell lung cancer: a comprehensive meta-analysis

Yao Ding1, Shun Lei2, Ling Wang1

  • 1Phase I Clinical Trial Ward, Chongqing University Cancer Hospital, Chongqing 400030, China.

Lung Cancer (Amsterdam, Netherlands)
|August 15, 2024
PubMed
Abstract

Insights

Older patients (75+) with non-small cell lung cancer (NSCLC) experience similar immunotherapy benefits as younger patients. This meta-analysis confirms immune checkpoint inhibitors (ICIs) are equally effective across age groups for NSCLC treatment.

Area of Science:

  • Oncology
  • Immunotherapy
  • Clinical Trials

Background:

  • Clinical trial data on immunotherapy effectiveness in advanced non-small cell lung cancer (NSCLC) is inconsistent regarding age-related efficacy.
  • Older individuals are often underrepresented in clinical trials, limiting understanding of immunotherapy benefits in this demographic.
  • Immune checkpoint inhibitors (ICIs) represent a significant advancement in NSCLC treatment.

Purpose of the Study:

  • To evaluate the efficacy of immune checkpoint inhibitors (ICIs) in older patients (≥75 years) with advanced non-small cell lung cancer (NSCLC).
  • To compare the overall survival (OS) benefits of ICIs between elderly and younger NSCLC patient cohorts.

Main Methods:

  • A comprehensive literature review was conducted up to April 2024 to identify relevant phase II or III randomized clinical trials.
  • Hazard ratios (HRs) for overall survival (OS) were extracted and analyzed across different age groups (under 75 years vs. 75 years and older).
  • The ratio of HRs (RHR) was computed to directly compare survival outcomes between the age groups.

Main Results:

  • Analysis of 13 randomized clinical trials revealed an HR for OS of 0.75 in patients under 75 years and 0.87 in patients aged 75 years and older.
  • The combined RHR for patients aged 75 and older compared to those under 75 was 1.14, indicating no significant difference in OS benefit (P=0.697).
  • Subgroup analyses confirmed consistent OS benefits of ICIs across all age groups and patient subgroups.

Conclusions:

  • This meta-analysis found no significant difference in the efficacy of immunotherapy for non-small cell lung cancer (NSCLC) between patients aged 75 years and older and those younger than 75.
  • The effectiveness of immune checkpoint inhibitors (ICIs) in treating NSCLC is consistent across different age demographics.
  • These findings support the use of ICIs in elderly NSCLC patients, addressing the historical underrepresentation in clinical trials.
Keywords:
AgeImmune checkpoint inhibitorMeta-analysisNon-small cell lung cancer

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