Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context
Summary: Background: Immune checkpoint inhibitors (ICIs) are the preferred treatments for advanced non-small cell lung cancer (NSCLC) without targetable oncogene alterations. However, evidence in the elderly population (aged ≥ 65 years) remains limited. Methods: We searched PubMed, Embase, Cochrane...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025000136 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832573091008479232 |
|---|---|
| author | Jiacheng Yao Sihan Li Lu Bai Jun Chen Chengbo Ren Tingting Liu Jingping Qiu Jun Dang |
| author_facet | Jiacheng Yao Sihan Li Lu Bai Jun Chen Chengbo Ren Tingting Liu Jingping Qiu Jun Dang |
| author_sort | Jiacheng Yao |
| collection | DOAJ |
| description | Summary: Background: Immune checkpoint inhibitors (ICIs) are the preferred treatments for advanced non-small cell lung cancer (NSCLC) without targetable oncogene alterations. However, evidence in the elderly population (aged ≥ 65 years) remains limited. Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases for eligible publications until September 30, 2024. The primary outcome of interest was overall survival (OS). A random-effects model was used for the statistical analysis. Findings: A total of 35 phase 3 randomized controlled trials (RCTs) involving 9788 patients and 64 real-world studies involving 37,111 patients were included. Results from phase 3 RCTs revealed that ICIs significantly improved OS (hazard ratio [HR] = 0.78, 95% confidence interval [CI]: 0.74–0.82) and progression-free survival (PFS) (HR = 0.67, 95% CI: 0.60–0.75) compared to chemotherapy. The association between ICIs and improved OS was independent of patient characteristics (race and histological type) or treatment-related factors (ICI drug type, treatment mode, and treatment line). However, significantly prolonged OS was not observed in subgroups of aged ≥ 75 years and PD-L1 < 1%. In real-world studies, the pooled median OS of ICIs were 11.8 months (95% CI: 11.2–12.4); Eastern Cooperative Oncology Group (EOCG) score, histological type, PD-L1 status, with immune-related adverse events (irAEs), and treatment mode were predictive for OS; rates of irAEs and discontinuation were numerically higher for combination therapy vs. monotherapy. Interpretation: ICIs are associated with a significant improvement in OS and PFS compared to chemotherapy in elderly patients with advanced NSCLC. Nevertheless, some patient characteristics such as aged ≥ 75 years, ECOG score ≥ 2, and PD-L1 < 1% seem to have a negative impact on the efficacy of ICIs, while these findings require further validation in large RCTs. Funding: None. |
| format | Article |
| id | doaj-art-881fb6726c8d462cb5a13fb8d46790de |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-881fb6726c8d462cb5a13fb8d46790de2025-02-02T05:29:11ZengElsevierEClinicalMedicine2589-53702025-03-0181103081Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in contextJiacheng Yao0Sihan Li1Lu Bai2Jun Chen3Chengbo Ren4Tingting Liu5Jingping Qiu6Jun Dang7Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, ChinaDepartment of Radiation Oncology, The First Hospital of China Medical University, Shenyang, ChinaDepartment of Radiation Oncology, The First Hospital of China Medical University, Shenyang, ChinaDepartment of Radiation Oncology, Shenyang Tenth People’s Hospital, Shenyang, ChinaDepartment of Radiation Oncology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, ChinaDepartment of Radiation Oncology, Anshan Cancer Hospital, Anshan, ChinaDepartment of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China; Corresponding author.Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China; Corresponding author.Summary: Background: Immune checkpoint inhibitors (ICIs) are the preferred treatments for advanced non-small cell lung cancer (NSCLC) without targetable oncogene alterations. However, evidence in the elderly population (aged ≥ 65 years) remains limited. Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases for eligible publications until September 30, 2024. The primary outcome of interest was overall survival (OS). A random-effects model was used for the statistical analysis. Findings: A total of 35 phase 3 randomized controlled trials (RCTs) involving 9788 patients and 64 real-world studies involving 37,111 patients were included. Results from phase 3 RCTs revealed that ICIs significantly improved OS (hazard ratio [HR] = 0.78, 95% confidence interval [CI]: 0.74–0.82) and progression-free survival (PFS) (HR = 0.67, 95% CI: 0.60–0.75) compared to chemotherapy. The association between ICIs and improved OS was independent of patient characteristics (race and histological type) or treatment-related factors (ICI drug type, treatment mode, and treatment line). However, significantly prolonged OS was not observed in subgroups of aged ≥ 75 years and PD-L1 < 1%. In real-world studies, the pooled median OS of ICIs were 11.8 months (95% CI: 11.2–12.4); Eastern Cooperative Oncology Group (EOCG) score, histological type, PD-L1 status, with immune-related adverse events (irAEs), and treatment mode were predictive for OS; rates of irAEs and discontinuation were numerically higher for combination therapy vs. monotherapy. Interpretation: ICIs are associated with a significant improvement in OS and PFS compared to chemotherapy in elderly patients with advanced NSCLC. Nevertheless, some patient characteristics such as aged ≥ 75 years, ECOG score ≥ 2, and PD-L1 < 1% seem to have a negative impact on the efficacy of ICIs, while these findings require further validation in large RCTs. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537025000136Immune checkpoint inhibitorsOverall survivalNon-small cell lung cancerElderlyMeta-analysis |
| spellingShingle | Jiacheng Yao Sihan Li Lu Bai Jun Chen Chengbo Ren Tingting Liu Jingping Qiu Jun Dang Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context EClinicalMedicine Immune checkpoint inhibitors Overall survival Non-small cell lung cancer Elderly Meta-analysis |
| title | Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context |
| title_full | Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context |
| title_fullStr | Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context |
| title_full_unstemmed | Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context |
| title_short | Efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer: a systematic review and meta-analysisResearch in context |
| title_sort | efficacy and safety of immune checkpoint inhibitors in elderly patients with advanced non small cell lung cancer a systematic review and meta analysisresearch in context |
| topic | Immune checkpoint inhibitors Overall survival Non-small cell lung cancer Elderly Meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025000136 |
| work_keys_str_mv | AT jiachengyao efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT sihanli efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT lubai efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT junchen efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT chengboren efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT tingtingliu efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT jingpingqiu efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext AT jundang efficacyandsafetyofimmunecheckpointinhibitorsinelderlypatientswithadvancednonsmallcelllungcancerasystematicreviewandmetaanalysisresearchincontext |