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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Wednesday, May 1, 2024
A group of researchers aimed to evaluate the efficacy of an immune checkpoint inhibitor plus chemotherapy for the treatment of non–small cell lung cancer (NSCLC). Although the use of immune checkpoint inhibitors has been a breakthrough in the treatment of this type of lung cancer, patients aged 75 and older were seldom included in the supportive phase III trials. Hajime Asahina, MD, PhD, of Hokkaido University Graduate School of Medicine, Sapporo, Japan, and colleagues reported their findings in JAMA.
“In this study, immune checkpoint inhibition/chemotherapy combination treatment did not improve survival compared with immune checkpoint inhibition alone but increased the incidence of grade 3 and higher immune-related adverse events for patients 75 years and older in clinical practice,” the study authors concluded. “Based on these results, immune checkpoint inhibition alone may be recommended for older adult patients with PD-L1–positive NSCLC.”
The researchers analyzed data from 1,245 patients (aged 75 and older) with clinical stage IIIB, IIIC, IV, postoperative or radiotherapy recurrent NSCLC. PD-L1 expression of less than 1% was confirmed in 268 tumors; 1% to 49%, in 387 tumors; and 50% and higher, in 410 tumors. A total of 155 patients received single-agent chemotherapy; 311 patients received platinum-doublet therapy; 425 patients received an immune checkpoint inhibitor; and 354 patients received an immune checkpoint inhibitor plus chemotherapy.
After the investigators performed propensity score matching, no difference in overall survival or progression-free survival was seen between an immune checkpoint inhibitor plus chemotherapy and an immune checkpoint inhibitor alone. Immune checkpoint inhibition plus chemotherapy was also shown to increase the incidence of grade 3 and higher immune-related adverse events compared with an immune checkpoint inhibitor alone.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
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