Highlights from

ELCC 2019

European Lung Cancer Conference

Geneva 10-13 April 2019

Immunotherapy in elderly: diverse findings across the globe

Age-related decline of the immune system might affect the efficacy of immunotherapy in older patients. Results from an observational retrospective study from Spain suggest that elderly patients with advanced non-small cell lung cancer (NSCLC) could have worse survival outcomes with immunotherapy than younger patients. In contrast, a pooled analysis of 3 trials supports the use of pembrolizumab monotherapy in elderly patients (≥75 years) with advanced PD-L1‒expressing NSCLC.

Roughly half of all patients with newly diagnosed NSCLC are elderly. However, there is little evidence on the efficacy and safety of immunotherapy in this age group.

Retrospective study from Spain

Dr Elena Corral de la Fuente (Hospital Universitario Ramon y Cajal, Madrid, Spain) and colleagues retrospectively reviewed all 98 patients with advanced NSCLC treated with immunotherapy agents at their hospital between 2014 and 2018. Of them, 27.5% were aged 70 years or older. Overall survival (OS) in these elderly patients was significantly shorter than in patients <70 years of age (median 5.5 vs 13 months, hazard ratio 3.86, P<0.0001). Progression-free survival (PFS) was also significantly shorter in elderly patients than in younger patients (1.8 vs 3.6 months, HR 2.1, P=0.012). There were no statistically significant differences in immune-related adverse events between elderly and younger patients (P=0.535).

Study from Japan

In a pooled analysis from 3 randomised trials (KEYNOTE-010, -042, and -024), Dr Kaname Nosaki (National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan) and co-investigators demonstrated significantly improved OS in 264 patients aged >75 years with advanced NSCLC who were treated with pembrolizumab vs chemotherapy. In addition, the investigators compared the results for elderly patients with results for 2,292 participants aged <75 years. All of the patients had PD-L1 tumour proportion scores (PD-L1 TPS) of ≥1%. Half of the elderly group in this analysis had PD-L1 TPS of >50%. Elderly patients with PD-L1 TPS >1% treated with pembrolizumab, showed significantly improved OS compared to those treated with chemotherapy (HR 0.76). The improvement in OS with pembrolizumab compared to chemotherapy was even greater in patients with PD-L1 TPS >50% (HR 0.41).

  1. Corral de la Fuente E. Benefit of immunotherapy (IT) in advanced non-small cell lung cancer (NSCLC) in elderly patients (EP). ELCC 2019, Geneva, Switzerland; abstract 169P_PR.
  2. Nosaki K. Safety and efficacy of pembrolizumab (Pembro) monotherapy in elderly patients (Pts) with PD-L1-positive advanced NSCLC: Pooled analysis from KEYNOTE-010, -024 and -042. ELCC 2019, Geneva, Switzerland; abstract 103O_PR.

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.