Retrospective study on the tolerability using a four-cycle completion in elderly patients with extensive-stage...

The combination of an anti-programmed death-ligand 1 (PD-L1) antibody with etoposide and either carboplatin or cisplatin (platinum-etoposide) has become the first-line treatment for patients with extensive-stage small-cell lung cancer (ES-SCLC). Although previous studies have examined the relationship between geriatric assessments and treatment efficacy, the association with treatment tolerability in elderly patients with ES-SCLC remains insufficiently understood. We aimed to evaluate the association between low body mass index (BMI)-a component of geriatric assessment-and treatment tolerability.

We conducted a retrospective analysis of patients aged ≥65 years with ES-SCLC who received anti-PD-L1 antibody plus platinum-etoposide at a single center between August 2019 and April 2024. Tolerability was defined as the completion of four cycles of anti-PD-L1 antibody combined with platinum-etoposide. We also assessed treatment efficacy and safety profiles.

A total of 71 patients were included, with a median age of 73 years (range: 65-91 years). Of these, 51 patients (72%) were male, and 54 (76%) had an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0 or 1. Sixteen patients (23%) showed a low BMI (<19 kg/m2), whereas 55 (77%) showed a non-low BMI. Tolerability was achieved in 8 patients (50%) with low BMI compared with 44 patients (80%) with non-low BMI. There were no significant differences in overall survival, progression-free survival, or the incidence of grade ≥3 adverse events among the two groups. In multivariate analysis, low BMI and ECOG-PS ≥2 were independently associated with reduced treatment tolerability [odds ratio (OR): 0.24, 95% confidence interval (CI): 0.06-0.88, P=0.03; OR: 0.13, 95% CI: 0.04-0.48, P<0.01, respectively].

Low BMI and poor performance status were independently associated with decreased tolerability to anti-PD-L1 antibody combined with platinum-etoposide in elderly patients with ES-SCLC. These findings underscore the importance of incorporating geriatric assessments into treatment decision-making for this population.