Real-world data on immunotherapy combined with chemotherapy in elderly patients with extensive-stage small cell lung cancer.

Abstract

Background: Immunotherapy combined with chemotherapy has shown good results in the treatment of extensive-stage small cell lung cancer (ES-SCLC), but there are fewer clinical studies on elderly ES-SCLC patients. This study was aimed to evaluate the efficacy and safety of immunotherapy in combination with chemotherapy in elderly patients with ES-SCLC.

Methods: Elderly patients with ES-SCLC who were 70 years of age or older and were diagnosed at Shandong Cancer Hospital from May 20, 2020, to February 24, 2023, were included in this study. Overall survival (OS) and progression-free survival (PFS) were calculated via the Kaplan‒Meier method and compared via the log-rank test. In addition, the Cox regression model was used to analyze prognostic factors.

Results: A total of 135 patients were included in this study; 82 patients were in the immunotherapy combined with chemotherapy (IO + ChT) group, and 53 patients were in the chemotherapy alone (ChT-alone) group. The median overall survival (mOS) for the entire patient cohort was 12.89 months, whereas the median progression-free survival (mPFS) was 7.21 months. There was a significant difference in mPFS (8.26 months vs. 6.59 months, P =.02) and no statistically significant difference in mOS (14.20 months vs. 11.44 months, P =.14) between the IO + ChT and ChT-alone groups. The incidence of grade ≥ 3 adverse events in the IO + ChT group was not significantly different from that in the ChT-alone group. Moreover, we did not observe grade ≥ 3 immune-related adverse reactions. The univariate multifactorial analysis demonstrated that the absence of liver metastases at baseline and in female patients were favorable prognostic factors for OS, and the addition of immunotherapy was a favorable prognostic factor that improved overall survival in elderly patients with ES-SCLC. Subgroup analyses indicated that adding immunotherapy provided a survival benefit for patients with baseline brain metastases and baseline liver-free metastases.

Conclusion: Immunotherapy combined with chemotherapy can provide a survival benefit, and the addition of immunotherapy does not result in significant toxicity in elderly patients. The results of this study have important clinical implications for the future treatment of elderly patients with ES-SCLC.