Pembrolizumab Plus Chemotherapy Versus Chemotherapy Monotherapy as a First-Line Treatment in Elderly Patients (≥75 Years Old) With Non-Small-Cell Lung Cancer

Yang, Zhengyu; Chen, Ya; Wang, Yanan; Hu, Maoliang; Qian, Fangfei; Zhang, Yanwei; Zhang, Bo; Zhang, Wei; Han, Baohui

doi:10.3389/fimmu.2022.807575

Cited by 7 publications

(8 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Observational data from clinical practice for pembrolizumab plus chemotherapy for older adult patients in China indicated that grade 3 and higher pneumonitis occurred in 9%, and AEs leading to discontinuation registered 26%. 19 Another study conducted in Italy reported grade 3 and higher pneumonitis occurring in 10.2% of patients receiving a combination of pembrolizumab, platinum, and pemetrexed with a median age of 68 years. 31 Furthermore, Morimoto et al 32 reported that the incidence of grade 3 and higher pneumonitis reached 16.0% in patients 75 years and older who received pembrolizumab with platinum and pemetrexed in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…Although higher rates were observed in clinical practice compared with those reported from the clinical trials, several retrospective studies have also reported a high incidence of pneumonitis in patients on ICI-chemotherapy combination treatment. Observational data from clinical practice for pembrolizumab plus chemotherapy for older adult patients in China indicated that grade 3 and higher pneumonitis occurred in 9%, and AEs leading to discontinuation registered 26% . Another study conducted in Italy reported grade 3 and higher pneumonitis occurring in 10.2% of patients receiving a combination of pembrolizumab, platinum, and pemetrexed with a median age of 68 years .…”

Section: Discussionmentioning

confidence: 99%

“…In a pooled analysis of anti–PD-1 and PD-L1 therapy in combination with chemotherapy vs immunotherapy alone, the OS benefit of adding chemotherapy was not demonstrated for patients 75 years and older . Even for data on pembrolizumab plus chemotherapy from clinical practice, the number of older adult patients is extremely limited . Therefore, we conducted a large retrospective study to determine the optimal choice of first-line drugs in older adults from clinical practice data and evaluate the efficacy and safety of combination ICI-chemotherapy treatment.…”

Section: Introductionmentioning

confidence: 99%

“…16 Even for data on pembrolizumab plus chemotherapy from clinical practice, the number of older adult patients is extremely limited. [17][18][19][20] Therefore, we conducted a large retrospective study to determine the optimal choice of first-line drugs in older adults from clinical practice data and evaluate the efficacy and safety of combination ICI-chemotherapy treatment.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Immunotherapy or Chemoimmunotherapy in Older Adults With Advanced Non–Small Cell Lung Cancer

Tsukita,

Tozuka,

Kushiro

et al. 2024

JAMA Oncol

View full text Add to dashboard Cite

ImportanceImmune checkpoint inhibitor (ICI) plus chemotherapy combination treatment (ICI-chemotherapy) is now a standard treatment for non–small cell lung cancer (NSCLC) without targetable oncogene alterations, but there are few data on ICI-chemotherapy for patients 75 years and older.ObjectiveTo inform the choice of first-line drugs in clinical practice and assess the safety and efficacy of ICI-chemotherapy combination treatment in older adult patients with previously untreated advanced NSCLC.Design, Setting, and ParticipantsThis retrospective cohort study included 58 centers in Japan. The cohort consisted of patients 75 years and older with clinical stage IIIB, IIIC, IV, postoperative or radiotherapy recurrent NSCLC. Patients started first-line systemic therapy between December 2018 and March 2021. Those receiving first-line molecular targeted drugs were excluded. The data were analyzed from February 2022 to October 2022.ExposuresSystemic therapy.Main Outcomes and MeasuresThe main outcomes were overall survival (OS), progression-free survival (PFS), and safety.ResultsA total of 1245 patients (median [range] age, 78 [75-95] years; 967 [78%] male) with NSCLC were included in the cohort. Programmed death ligand–1 (PD-L1) expression of less than 1% occurred in 268 tumors (22%); 1% to 49% in 387 tumors (31%); 50% and higher in 410 tumors (33%), and unknown expression in 180 tumors (14%). Median OS was 20.0 (95% CI, 17.1-23.6) months for the 354 patients receiving ICI-chemotherapy (28%); 19.8 (95% CI, 16.5-23.8) months for the 425 patients receiving ICI alone (34%); 12.8 (95% CI, 10.7-15.6) months for the 311 patients receiving platinum-doublet chemotherapy (25%); and 9.5 (95% CI, 7.4-13.4) months for the 155 patients receiving single-agent chemotherapy (12%). After propensity score matching, no differences in OS and PFS were found between the patients receiving ICI-chemotherapy vs ICI alone. Each group consisted of 118 patients. For PD-L1 expression of 1% and higher the OS hazard ratio (HR) was 0.98 (95% CI, 0.67-1.42; P = .90), and the PFS HR was 0.92 (95% CI, 0.67-1.25; P = .59). Significance was also not reached when separately analyzed for lower or higher PD-L1 expression (1%-49% or ≥50%). However, grade 3 or higher immune-related adverse events occurred in 86 patients (24.3%) treated with ICI-chemotherapy and 76 (17.9%) with ICI alone (P = .03).Conclusions and RelevanceIn this study, ICI-chemotherapy combination treatment did not improve survival and increased the incidence of grade 3 and higher immune-related adverse events compared with ICI alone in patients 75 years and older. Based on these results, ICI alone may be recommended for older adult patients with PD-L1–positive NSCLC.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Immunotherapy or Chemoimmunotherapy in Older Adults With Advanced Non–Small Cell Lung Cancer

Tsukita,

Tozuka,

Kushiro

et al. 2024

JAMA Oncol

View full text Add to dashboard Cite

show abstract

“…Poor PS and elderly patients, as well as patients with serious comorbidities, have not been enrolled in pivotal chemo-immunotherapy trials so no data on these challenging populations are available [ 26 , 27 ]. On the other hand, older age per se seemed not be an absolute contraindication to immunotherapy combinations with platinum [ 28 ], but a definitive conclusion cannot be drawn. Our findings pointed out that the definition of platinum-fitness is mainly based on PS, age and comorbidities, hence “unfit” patients should be directly excluded from such combination treatments.…”

Section: Discussionmentioning

confidence: 99%

Selection Criteria and Treatment Outcome for Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Unfit for Platinum-Based First-Line Therapy: Results of the MOON-OSS Observational Trial

Camerini

Conte

Pezzuto

et al. 2022

Cancers

View full text Add to dashboard Cite

Limited evidence is available concerning the selection criteria and the outcomes of platinum unfit newly diagnosed advanced NSCLC patients receiving single-agent chemotherapy. We retrospectively collected data on consecutive, stage IIIB-IV, EGFR/ALK negative and PD-L1 < 50% NSCLC patients treated with first-line single agent chemotherapy. Baseline characteristics, outcome measures and toxicities were recorded, as well as criteria according to which treatment selection was made and what percentage of patients did not receive a first-line platinum-based chemotherapy. Two-hundred and twenty-one patients were included. Median age was 79 (range 56–92) years, M/F 165(74.6%)/56(25.4%), ECOG performance status (PS) 0/1/ ≥ 2 23(10.9%)/94(42.5%)/103(46.6%), with a median of two serious comorbidities. A median of 25% (range 10%-30%) of newly diagnosed NSCLC did not receive a first-line platinum combination. Clinical criteria according to which decision was made were older age (76.5%), comorbidities (72%), poor PS (55.2%) and familiar or social issues (10%). Single-agent treatment consisted of oral metronomic vinorelbine (MetV 78.6%), gemcitabine (Gem 10%), oral standard vinorelbine (Vin 8.2%) and other (O 3.2%). Median progression-free survival (PFS) and overall survival (OS) of single agent treatments ranged from 4.5 to 5 months and from 9 to 10.5 months, respectively. All grade toxicities did not differ among single agents, while grade 3–4 toxicities were less frequent with MetV. Up to 30% of newly diagnosed advanced EGFR/ALK negative and PD-L1 < 50% NSCLC patients do not receive a first-line platinum doublet. Main clinical selection criteria were older age (>70 years), comorbidities and poor PS. An oral treatment was frequently proposed with MetV being the most frequent choice according to its safety profile.

show abstract

Treatment at Twilight: An Analysis of Therapy Patterns and Outcomes in Adults 80 Years and Older With Advanced or Metastatic NSCLC

Burns,

Chen,

Mathur

et al. 2023

JTO Clinical and Research Reports

View full text Add to dashboard Cite

Pembrolizumab Plus Chemotherapy Versus Chemotherapy Monotherapy as a First-Line Treatment in Elderly Patients (≥75 Years Old) With Non-Small-Cell Lung Cancer

Cited by 7 publications

References 27 publications

Immunotherapy or Chemoimmunotherapy in Older Adults With Advanced Non–Small Cell Lung Cancer

Immunotherapy or Chemoimmunotherapy in Older Adults With Advanced Non–Small Cell Lung Cancer

Selection Criteria and Treatment Outcome for Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Unfit for Platinum-Based First-Line Therapy: Results of the MOON-OSS Observational Trial

Treatment at Twilight: An Analysis of Therapy Patterns and Outcomes in Adults 80 Years and Older With Advanced or Metastatic NSCLC

Contact Info

Product

Resources

About