medwireNews: The overall survival (OS) benefit offered by immune checkpoint inhibitors (ICIs) in people with advanced non-small-cell lung cancer (NSCLC) varies by age, suggests a real-world study.
The differences in OS between older and younger patients was observed “despite similarly rapid and substantial uptake of ICIs across all ages” following the first US FDA approval of an ICI for NSCLC in 2015, note Cary Gross (Yale School of Medicine, New Haven, Connecticut, USA) and team in JAMA Oncology.
The researchers collated data from the Flatiron Health database on 53,719 individuals diagnosed with stage IIIB–IV NSCLC between January 2011 and December 2019. The median age of the patients was 68.5 years and just over two-thirds (67.6%) were White.
In the overall cohort, the proportion of patients who received treatment increased significantly from 69.0% in 2011 to 77.2% in 2019, as did the proportion receiving upfront ICI therapy, from 4.7% in 2015 to 45.6% in 2019.
The increases in ICI use were similar across age groups and there was a comparable rate of first-line ICI use between the youngest (<55 years) and oldest (≥75 years) patients in 2019, at 45.2% and 43.8%, respectively.
However, younger patients derived a greater OS benefit from the use of ICIs than their older counterparts.
The median OS duration increased from 11.5 months in 2011 to 16.0 months in 2019 for patients younger than 55 years, from 12.9 to 15.0 months for those aged 55–64 years, and from 11.2 to 13.3 months for those aged 65–74 years. The oldest patients, aged 75 years or older, experienced the smallest increase, from 9.1 months in 2011 to 10.2 months in 2019.
Similarly, the predicted probability of 2-year survival rose from 37.7% in 2011–2013 to 50.3% in 2017–2018 in the youngest age group, which gave a statistically significant difference of 12.6 percentage points. But the oldest patients saw only “a modest improvement,” albeit statistically significant, of 5.6 percentage points, with respective 2-year survival probabilities of 30.6% and 36.2%, report Gross and colleagues.
“Among younger patients, median survival increased on the order of 4 to 5 months. This change meets the ASCO and ESMO threshold for a clinically meaningful benefit, suggesting that the adoption of ICIs has been associated with meaningful benefit for younger patients with NSCLC,” they summarize.
“Conversely, survival improvements were less impressive in the oldest age group, with survival improving by approximately 1 month, failing to meet either ASCO or ESMO criteria for clinically meaningful survival benefit.”
The team continues: “However, we have not examined other meaningful outcomes, including treatment burden, [quality of life], and symptom severity, that may be relevant in this population.”
The authors of a related commentary say that “[t]hese findings have relevant clinical implications given that the median age at lung cancer diagnosis is 71 years.”
Marjory Charlot (University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, USA) and Jhanelle Gray (H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA) believe that the “represents an important step in defining clinically meaningful benefits of ICIs in clinical practice across all age strata.”
But they add that “opportunities remain to gain a deeper understanding of the effect of ICIs on survival,” as the current study lacked “data on PD-L1 expression level, performance status, and stratification of results by tumor histology.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2023 Springer Healthcare Ltd, part of the Springer Nature Group
JAMA Oncol 2023; doi:10.1001/jamaoncol.2022.6901
JAMA Oncol 2023; doi:10.1001/jamaoncol.2022.6867