Abstract 2026: Outcomes in elderly patients with non-small-cell lung cancer receiving immune checkpoint inhibitor therapy: A real world experience
Authors: Ripp Jacob , Mohyuddin Ghulam R. , Al-Jumayli Mohammed , Huang Chao 
Published: September 2020

Introduction

This study examines outcomes in older adults with non-small-cell lung carcinoma (NSCLC) treated with immune checkpoint inhibitors (ICIs) - a population which has been underrepresented in clinical trials.

Methods

We performed a single-center retrospective study and collected data on safety and toxicity on patients with Stage IV NSCLC aged 65 or greater who were treated with ICI therapy from 2015 through 2017. Efficacy data included overall survival (OS) and progression free survival (PFS). Toxicity data included immune-related adverse events (irAEs) and need for glucocorticoids.

Results

A total of 48 patients aged 65 or greater were identified, with baseline characteristics noted in Table 1. The median OS of the entire cohort was 10 months (95% CI = 2.35-17.65 months). The median OS for patients 75 and older was 8 months vs. 10 months for patients aged 65-75 (p = 0.14). The median OS for patients with an ECOG of 1 was 13 months vs. 3 months for patients with an ECOG of 2 (p = 0.34). The median OS for patients receiving ICI as first line therapy was 18 months vs. 7 months for those receiving ICI as second line therapy or beyond (p = 0.11). The median OS for patients with PD-L1 expression 50% of greater was 10 months vs. 11 months for patients with PD-L1 expression less than 50% or unknown (p = 0.55). The median PFS for patients receiving ICI as first line therapy was 9 months vs. 2 months for those receiving ICI as second line therapy or beyond (p = 0.03). Eight (17%) patients had grade III/IV toxicity (3 pneumonitis, 1 CNS toxicity, 1 skin toxicity, 1 nephritis, 1 diarrhea, 1 hepatitis), and 8 patients (17%) received glucocorticoids related to their irAEs. Sixteen patients (33%) required hospitalization during treatment.

Table 1:Patient CharacteristicsPatient CharacteristicsAge65-7426 (54%)Age75, &gt;7522 (46%)Male24 (40%)ECOG Functional Status0-138 (79%)ECOG Functional Status2-310 (21%)HistologyAdenocarcinoma35 (73%)HistologySquamous cell carcinoma13 (27%)Type of immunotherapyNivolumab16 (33%)Type of immunotherapyPembrolizumab32 (67%)Line of therapy1st line28 (58%)Line of therapy2nd line or beyond20 (42%)PD-L1 Status50% or greater22 (46%)

Conclusions

Our study demonstrates the efficacy and safety of immunotherapy in elderly patients with NSCLC compared to cohorts in contemporary clinical trials. In our population, patients aged 75 or greater receiving immunotherapy did not have significantly lower overall survival compared to patients aged 65-75. Treatment was generally well-tolerated with 17% of patients developing grade III/IV toxicity.

Citation Format: Jacob Ripp, Ghulam R. Mohyuddin, Mohammed Al-Jumayli, Chao Huang. Outcomes in elderly patients with non-small-cell lung cancer receiving immune checkpoint inhibitor therapy: A real world experience [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2026.