P2.16-12 Treatment Uptake and Outcomes of Elderly Stage III NSCLC Patients: A 15-Year Retrospective Real-World Study

Incidence of non-small cell lung cancer (NSCLC) is highly correlated with age; the age-specific incidence rate of NSCLC in individuals ≥75 is nearly double that of patients <70. Further, nearly one-third of patients diagnosed with NSCLC present with locally advanced (Stage III) disease. This represents an anatomically heterogeneous, frequently non-resectable tumour for which contemporary practice guidelines, based on two decades of clinical trials, recommend concurrent chemoradiotherapy (cCRT) to maximize both local tumor control and survival. Underrepresentation of elderly patients in clinical trials requires the use of real-world populations to assess whether current recommendations and trial-derived survival outcomes are also applicable to this significant and growing age group. A 15-year population-based retrospective analysis of patients with de novo Stage III (AJCC 7th edition) NSCLC diagnosed between 1999-2014 was conducted. Demographic, clinical characteristics, treatment and outcome data were extracted from the institutional Glans-Look Lung Cancer Database. We defined elderly patients as those ≥75 years at diagnosis, and investigated the treatment intent, type, uptake and outcomes among elderly and non-elderly patients. We identified 1040 patients with a Stage III diagnosis. 333 (32%) were elderly. Treatment patterns differed significantly between elderly patients and non-elderly patients: elderly patients were less significantly likely to receive any form of active treatment (82% vs. 58%), particularly curative-intent treatment (41% vs. 14%), and no elderly patients underwent surgical resection. Median overall survival (mOS) favoured non-elderly patients (13.2 vs. 9.7 months, log-rank p <0.001.) Among elderly patients, receipt of curative-intent treatment was associated with significant improvement in mOS (17.4 months vs. 9.3 months for no active treatment/observation, vs. 8.5 months for palliative-intent treatment, p <0.001). When receiving curative-intent treatment, specifically cCRT, survival outcomes of elderly patients were not significantly different from those of younger patients (24.5 vs. 21.3 months, p=0.81), and had comparable 5-year survival rates (15.9% and 12.2% respectively). This real-world population reveals that elderly patients are less likely to receive any, and particularly, curative-intent treatment for their NSCLC diagnosis when compared with a younger cohort. When deemed suitable for a curative-intent regiment of cCRT, elderly patients show comparable outcomes to younger cohorts. This finding reinforces the current guideline recommendations that cCRT is associated with best outcome for non-resectable, locally-advanced NSCLC, even among elderly patients. Further, it supports the critical need for more tolerable and effective treatments for this presentation of disease to improve feasibility of curative-intent treatment for all, but in particular, elderly patients.