Outcomes of chemotherapy with or without immunotherapy in older patients with non-small cell lung cancer and low PD-L1 expression.

IF 4 2区 医学 Q2 ONCOLOGY
Translational lung cancer research Pub Date : 2025-05-30 Epub Date: 2025-05-22 DOI:10.21037/tlcr-2024-1236
Hayato Kawachi, Tae Hata, Tadaaki Yamada, Yasuhiro Goto, Akihiko Amano, Yoshiki Negi, Satoshi Watanabe, Naoki Furuya, Tomohiro Oba, Tatsuki Ikoma, Akira Nakao, Keiko Tanimura, Hirokazu Taniguchi, Akihiro Yoshimura, Tomoya Fukui, Daiki Murata, Kyoichi Kaira, Shinsuke Shiotsu, Makoto Hibino, Asuka Okada, Yusuke Chihara, Takashi Kijima, Koichi Takayama
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引用次数: 0

Abstract

Background: Immune checkpoint inhibitors (ICIs) in combination with chemotherapy have demonstrated efficacy in the treatment of non-small cell lung cancer (NSCLC) with a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of 1-49%. However, older patients remain underrepresented in clinical trials, and optimal treatment strategies for this population remain unclear. This study sought to evaluate the efficacy and safety of first-line treatment with either platinum-based chemotherapy alone (Chemo) or in combination with ICIs (ICI/Chemo) in older patients with NSCLC who have low PD-L1 expression.

Methods: This retrospective multicenter study included patients diagnosed with advanced NSCLC (stage IIIB-IV) with a PD-L1 TPS of 1-49% from 19 Japanese institutions. We examined the relationship between baseline patient characteristics and treatment outcomes within each group. Propensity score matching (PSM) was used to balance patient characteristics between the ICI/Chemo and Chemo groups.

Results: We evaluated data from 613 patients, finding that the ICI/Chemo group (n=370) exhibited significantly longer median progression-free survival (PFS) and overall survival (OS) compared to the Chemo group (n=243). Among the 613 patients, 152 were aged ≥75 years. Of these, 63 received Chemo, while 89 underwent ICI/Chemo as first-line treatment. In this older cohort, ICI/Chemo significantly improved median PFS; however, no significant difference was observed in OS. Nonetheless, the incidence of grade ≥3 adverse events and pneumonitis of any grade was higher in the ICI/Chemo group compared to the Chemo group among older patients. Multivariate analysis using Cox proportional hazards models indicated that Eastern Cooperative Oncology Group performance status (ECOG PS) was significantly associated with PFS and OS. In older patients with ECOG PS 0, ICI/Chemo showed significant PFS benefits; in those with ECOG PS 1, both the PFS and OS were similar between the two groups.

Conclusions: ICI combined with chemotherapy may be a potentially effective treatment strategy for older patients with NSCLC and low PD-L1 expression. However, compared with the overall population, the benefits of adding ICI to chemotherapy were decreased, while the risk of toxicity may increase, making appropriate patient selection crucial for this population. Particularly, in patients with ECOG PS 1, the additional benefit of ICI over chemotherapy was minimal in terms of efficacy, suggesting that the introduction of ICI combined with chemotherapy should be carefully considered for this patient population.

老年非小细胞肺癌低PD-L1表达患者化疗加或不加免疫治疗的结果
背景:免疫检查点抑制剂(ICIs)联合化疗治疗程序性死亡配体1 (PD-L1)肿瘤比例评分(TPS)为1-49%的非小细胞肺癌(NSCLC)已被证明有效。然而,老年患者在临床试验中的代表性仍然不足,针对这一人群的最佳治疗策略仍不清楚。本研究旨在评估一线治疗单铂类化疗(Chemo)或联合ICIs (ICI/Chemo)对PD-L1低表达的老年NSCLC患者的疗效和安全性。方法:这项回顾性多中心研究纳入了19家日本机构诊断为晚期非小细胞肺癌(IIIB-IV期)、PD-L1 TPS为1-49%的患者。我们检查了每组患者基线特征与治疗结果之间的关系。倾向评分匹配(PSM)用于平衡ICI/Chemo组和Chemo组之间的患者特征。结果:我们评估了613例患者的数据,发现ICI/Chemo组(n=370)比Chemo组(n=243)表现出更长的中位无进展生存期(PFS)和总生存期(OS)。613例患者中,年龄≥75岁的有152例。其中63人接受了化疗,89人接受了ICI/化疗作为一线治疗。在这个老年队列中,ICI/Chemo显著改善了中位PFS;但在OS方面无明显差异。尽管如此,与化疗组相比,ICI/Chemo组中≥3级不良事件和任何级别肺炎的发生率更高。采用Cox比例风险模型进行多因素分析显示,东部合作肿瘤组(Eastern Cooperative Oncology Group)绩效状态(ECOG PS)与PFS和OS显著相关。在ECOG PS为0的老年患者中,ICI/Chemo显示出显著的PFS益处;在ECOG ps1组中,两组之间的PFS和OS相似。结论:ICI联合化疗可能是老年非小细胞肺癌低PD-L1表达患者的潜在有效治疗策略。然而,与总体人群相比,在化疗中加入ICI的益处降低,而毒性风险可能增加,因此对这一人群来说,适当的患者选择至关重要。特别是,在ECOG ps1患者中,ICI与化疗相比的额外益处在疗效方面是最小的,这表明对于这类患者群体,应仔细考虑ICI联合化疗的引入。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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