Clinical Impact of Upfront Dose Reduction of the First Cycle of First-Line Treatments on Safety and Survival in Elderly Patients With Non-Small Cell Lung Cancer.

Abstract

Background: The number of elderly patients with non-small cell lung cancer (NSCLC) is rapidly increasing worldwide. Elderly patients with NSCLC are less suited to active treatment than younger patients. Upfront dose reduction (UDR) of the first cycle of first-line treatment is sometimes chosen for elderly patients due to adverse events. We investigated the clinical impact of UDR in elderly NSCLC patients.

Methods: From a prospective database of consecutive NSCLC patients without actionable genomic alterations who received first-line treatment between November 2018 and March 2024, we analyzed 131 patients of ≥65 years of age. Patients were treated with standard-dose chemotherapy between November 2018 and December 2021 and UDR chemotherapy between January 2022 and March 2024. We retrospectively compared the incidence of adverse events and clinical outcomes between the standard-dose and UDR groups.

Results: The incidence of treatment-related death was relatively lower in the UDR group (UDR vs. standard-dose: 3.0 vs. 13.6%; p = 0.0624). There was no significant difference in the incidence of immune-related adverse events between the two groups. The objective response rate was higher in the UDR group (UDR vs. standard-dose: 61.5 vs. 48.5%; p = 0.161). The log-rank analysis showed that the UDR group had significantly longer median progression-free survival/overall survival relative to the standard-dose group.

Conclusions: UDR as a first-line treatment was safe and could be a suitable approach for elderly patients with NSCLC. Further research is needed to evaluate the clinical outcomes in the treatment of elderly NSCLC patients.