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Age-Stratified Long-Term Outcomes of Immune Checkpoint Inhibitors for Stage IV Melanoma and NSCLC in The Netherlands:
Eline G M Steenhuis1, Lieke M van Disseldorp2, Femke J C Jacobs2
1Department of Pulmonology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
Abstract:
Background: Immune checkpoint inhibitors (ICIs) are standard treatment for melanoma and non-small cell lung cancer (NSCLC), yet evidence on their effectiveness in older adults remains limited due to underrepresentation in clinical trials. This study assessed long-term, age-stratified outcomes of ICI treatment in real-world clinical practice. Methods: This nationwide observational study used data from the Netherlands Cancer Registry on patients with synchronous stage IV melanoma or NSCLC who received first-line ICIs between 2018 and 2023. Melanoma treatments included nivolumab plus ipilimumab or anti-PD-1 monotherapy; NSCLC treatments included pembrolizumab with or without chemotherapy. Primary outcomes were five-year overall survival (5-yr OS) and three-year conditional survival (3-yr CS), stratified by age. Results: A total of 11,140 patients were included, consisting of 583 patients with melanoma and 10,557 with NSCLC. In the melanoma population, 5-yr OS was 43.8%. Patients aged ≥ 75 years had a 5-yr OS of 30.8% and a 3-yr CS of 58.7%. In NSCLC treated with pembrolizumab monotherapy, 5-yr OS was 23.1%; among patients aged ≥ 75 years, 5-yr OS was 15.6% and 3-yr CS was 46.6%. Pembrolizumab combined with chemotherapy resulted in a 5-yr OS of 14.6%, with corresponding 5-yr OS of 8.4% and 3-yr CS of 35.5% in patients aged ≥ 75 years. Conclusions: This registry-based analysis suggests that ICI are associated with durable long-term survival in real-world patients with stage IV melanoma or NSCLC, including selected older adults. These findings are in line with outcomes of clinical trials, but further research is needed on predictors of ICI effectiveness in the older population.
Insights
Immune checkpoint inhibitors (ICIs) show durable long-term survival in real-world stage IV melanoma and non-small cell lung cancer (NSCLC) patients, including older adults. These findings support ICI effectiveness in diverse populations, warranting further research into geriatric efficacy predictors.
Area of Science:
- Oncology
- Immunotherapy
- Geriatric Medicine
Background:
- Immune checkpoint inhibitors (ICIs) are standard treatments for melanoma and non-small cell lung cancer (NSCLC).
- Limited data exists on ICI effectiveness in older adults due to clinical trial underrepresentation.
- Real-world data is crucial for assessing long-term, age-stratified outcomes in diverse patient populations.
Purpose of the Study:
- To assess long-term, age-stratified outcomes of first-line immune checkpoint inhibitor (ICI) treatment in real-world melanoma and NSCLC patients.
- To compare survival rates across different age groups, particularly focusing on older adults (≥ 75 years).
- To evaluate the real-world effectiveness of specific ICI regimens in stage IV melanoma and NSCLC.
Main Methods:
- Nationwide observational study utilizing the Netherlands Cancer Registry (2018-2023).
- Inclusion of 11,140 patients with synchronous stage IV melanoma or NSCLC receiving first-line ICIs.
- Analysis of five-year overall survival (5-yr OS) and three-year conditional survival (3-yr CS), stratified by age.
Main Results:
- Melanoma: 5-yr OS was 43.8% overall; 30.8% for patients ≥ 75 years.
- NSCLC (pembrolizumab monotherapy): 5-yr OS was 23.1% overall; 15.6% for patients ≥ 75 years.
- NSCLC (pembrolizumab + chemotherapy): 5-yr OS was 14.6% overall; 8.4% for patients ≥ 75 years.
Conclusions:
- Immune checkpoint inhibitors (ICIs) demonstrate durable long-term survival in real-world stage IV melanoma and NSCLC, including selected older adults.
- Findings align with clinical trial outcomes, suggesting broad applicability of ICIs across age groups.
- Further research is needed to identify predictors of ICI effectiveness specifically within the older adult population.
