Immune Checkpoint Inhibitors in Real‐World Treatment of Older Adults with Non–Small Cell Lung Cancer

Abstract

To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non-small cell lung cancer (NSCLC) seen in routine clinical practice. Retrospective study. Single academic institution and its affiliated centers. Patients aged ≥70 years with advanced stage NSCLC seen between 4/1/2015 and 4/1/2017 and treated with ICIs. Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities [Charlson comorbidity index (CCI)], and performance status, and estimated using the Kaplan-Meier method and log-rank test. Toxicity data included immune-related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and Eastern Cooperative Group Performance Status (ECOG PS) were evaluated using the exact Chi-square test or Fisher’s exact test. We included 75 patients (median age: 74 years, range 70-92); 53% had CCI ≥3 and 49% had ECOG PS ≥2. Median OS for the whole cohort was 8.2 months (ECOG PS 0-1 vs. ≥2: 13.7 vs. 3.8 months; p<0.01). Median TTF was 4.2 months (ECOG PS 0-1 vs. ≥2: 5.6 vs. 2.0 months; P=0.02). Overall, 37% of patients experienced irAE of any grade (a total of 37 events); 8% were Grade ≥3 (no ICI-related deaths). Of those who discontinued ICIs (N=64), 15% were due to irAEs. Of those who experienced irAEs, 64% required glucocorticoids. Hospitalizations during ICI treatment occurred in 72%. Toxicity generally did not differ by age, CCI, or ECOG PS. Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, glucocorticoids utilization, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era.