Systematic review and meta-analysis of immune checkpoint inhibitors in elderly patients with advanced non-small cell lung cancer

Immune checkpoint inhibitors (ICIs) are the preferred treatments for advanced non-small lung cancer (aNSCLC) without targetable alterations. However, evidence in the elderly population (aged ≥65 years) remains limited. A systematic review and meta-analysis of randomized studies published through September 1, 2024, found that ICIs compared with chemotherapy significantly improved progression-free survival (HR 0.67; 95% CI 0.60-0.75) and overall survival (0/78; 0.74-0.82) in elderly patients with aNSCLC. However, significantly prolonged OS was not observed in subgroups aged ≥ 75 years and PD-L1 expression < 1%. In real-world observational studies, ECOG performance score ≥2 was associated with reduced efficacy of ICIs. The authors conclude that ICIs are associated with improved PFS and OS compared to chemotherapy in elderly aNSCLC patients. Nevertheless, some patient characteristics seem to have a negative impact on the efficacy of ICIs.