Neoadjuvant immunotherapy in geriatric patients with non-small cell lung cancer: A real-world analysis

Neoadjuvant immunotherapy has been shown to significantly improve survival in patients with stage IB-IIIB non-small cell lung cancer. However, it is unknown whether geriatric patients experience similar benefits. Using a large national cohort, we studied outcomes of neoadjuvant immunotherapy in geriatric patients with stage IB-IIIB non-small cell lung cancer.

Patients with stage IB-IIIB non-small cell lung cancer treated over 24 months (2022-2023) were identified in the National Cancer Database. Geriatric patients were defined as being older than 75 years. Geriatric patients and younger patients aged 75 years or less were compared in terms of treatment intensity, perioperative outcomes, and survival. Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analysis of survival. Multivariable logistic regression was used to analyze perioperative outcomes.

21,070 patients aged more than 75 years with clinical stage IB-IIIB non-small cell lung cancer were included in this analysis. Among them, 4467 (21.2%) received surgery and 447 (10.0%) received neoadjuvant immunotherapy, compared with 35.3% and 17.9% of younger patients, respectively (P < .001). Both surgery (adjusted HR 0.34 [0.27-0.43], P < .001) and neoadjuvant immunotherapy (0.39 [0.25-0.63], P < .001) were associated with improved survival in geriatric patients. Geriatric patients who received neoadjuvant immunotherapy also demonstrated acceptable perioperative outcomes.

In a large national cohort, we show that although geriatric patients have lower treatment intensity than younger patients, both surgery and neoadjuvant immunotherapy render a survival benefit while retaining acceptable perioperative outcomes. Whenever possible, standard of care treatment should be pursued in geriatric patients, and age in isolation should not exclude patients from optimal treatments.