P10.02 Improved Survival of Elderly Patients with NSCLC Treated in the Immunotherapy Era: A Historical Cohort Study

Immune checkpoint inhibitors (ICI) have revolutionized the treatment of patients with non-small cell lung cancer (NSCLC). However, elderly patients are often under-represented in clinical trials, and the benefit of ICI in special populations remains unclear. This study aimed to evaluate treatment patterns and survival outcomes of elderly patients with NSCLC treated in the immunotherapy era compared to historical data. We reviewed a consecutive series of elderly patients (age ≥75) diagnosed with stage IIIB-IV non-oncogene addicted NSCLC at the University Hospital of Udine, Italy, from January 2013 to December 2020. Patients were grouped into a historical (HC, 2013-2016) and a contemporary cohort (CC, 2017-2020) according to the year of approval of ICI for the treatment of NSCLC in Italy. Baseline variables, treatment patterns, and overall survival (OS) were compared. Overall, 180 patients were included (Table 1). The median age was 80 years (range: 75-93), 78% of patients were stage IV, and 63% had adenocarcinoma. Of note, 25% presented with a PS ≥2, and 24% with a Charlson Comorbidity Index ≥3. At baseline, a greater proportion of patients in the CC received a first-line treatment (76% vs 62%, p=0.04), a second-line treatment (47% vs 32%, p=0.09), and were aged ≥80 years (63% vs. 43%, p=0.009) compared to the HC. Among treated patients, 60% in the CC and 16% in the HC received immunotherapy. A prolonged OS was observed for the CC compared to the HC when considering all patients (8.27 vs. 4.23 months, HR 0.65, 95% CI 0.47-0.89, p <0.01) and those actively treated (10.57 vs. 6.86 months, HR 0.61, 95% CI 0.41-0.92, p =0.01, Figure 1).Table 1SubgroupsWhole cohort n=180 (%)2013-2016 n=102 (%)2017-2020 n=78 (%)pAge range75-79≥8087 (48.3)93 (51.7)58 (56.9)44 (43.1)29 (37.2)49 (62.8)<0.01Age cont. (years, median)Min-Max [25-75 percentiles]8075-93 [77-83]78.575-89 [76-82]8075-93 [79-84]0.001Male sex141 (78.3)80 (78.4)61 (78.2)0.97KRASMutatedWild typeUnknown49 (27.2)66 (36.7)65 (36.1)31 (30.4)31 (30.4)40 (39.2)18 (23.1)35 (44.9)25 (32.0)0.08PD-L1 TPS01-49%≥50%Unknown24 (13.3)12 (6.7)21 (11.7)123 (68.3)1 (0.9)00101 (99.1)23 (29.5)12 (15.4)21 (26.9)22 (28.2)0.49HistologyAdenocarcinomaSquamousNot otherwise specified114 (63.3)51 (28.3)15 (8.3)66 (64.7)27 (26.5)9 (8.8)48 (61.5)24 (30.8)6 (7.7)0.80TNM StageIIIBIV40 (22.2)140 (77.8)25 (24.5)77 (75.5)15 (19.2)63 (80.8)0.39ECOG performance status ≥245 (25.0)23 (22.5)22 (28.2)0.43Liver localizations15 (8.3)7 (6.7)8 (10.2)0.41CNS localizations16 (8.9)10 (9.8)6 (7.7)0.62Bone localizations30 (16.7)20 (19.8)10 (12.8)0.22Adrenal localizations27 (15.0)19 (18.6)8 (10.2)0.12Soft tissue localizations12 (6.7)6 (5.8)6 (7.6)0.63Pleural effusion23 (12.8)11 (10.7)12 (15.3)0.36Charlson Comorbidity Index ≥344 (24.4)27 (26.5)17 (21.8)0.47Charlson Comorbidity Index cont. (median)Min-Max [25-75 percentiles]10-8 [0-2]10-8 [0-3]10-8 [0-2]0.59First-line treatmentBest supportive carePlatinum-based chemotherapyChemo-immunotherapyImmunotherapySingle-agent chemotherapy58 (32.2)54 (30.0)1 (0.5)15 (8.3)52 (28.8)39 (38.2)34 (33.3)0029 (28.4)19 (24.4)20 (25.6)1 (1.2)15 (19.2)23 (29.4)<0.0001Second-line treatment44/113 (38.9)19/60 (31.7)25/53 (47.2)0.09Immunotherapy after first-line25/113 (22.1)6/60 (10.0)19/53 (35.8)<0.0001 Open table in a new tab In our cohort, the advent of immunotherapy had a significant impact on survival in elderly patients with NSCLC, with a higher proportion of patients treated at first and second-line.