Overall survival in elderly patients with advanced NSCLC favored those receiving pembrolizumab over chemotherapy and resulted in fewer treatment-related adverse effects, particularly of grade 3-5.
Why this matters
The elderly make up approximately 70% of all cases of newly diagnosed non-small-cell lung cancer (NSCLC). In clinical trials on the safety and efficacy of immunotherapies, this population has been underrepresented, so the findings may not be applicable to them.
Efficacy and safety results for 264 elderly patients aged ≥75 years and treated with the anti-PD-L1 antibody pembrolizumab for advanced NSCLC were pooled from studies KEYNOTE-010, KEYNOTE-024, and KEYNOTE-042. All patients had a tumor proportion score for PD-L1 of at least 1%, and half had a Tumor Proportion Score (TPS) of 50% or greater.
- The overall survival (OS) for elderly patients favored those given pembrolizumab over regular chemotherapy (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.56-1.02). The difference was significant for those patients with a TPS ≥50% (HR 0.40; CI 0.25–0.64).
- Comparing one-year OS between the elderly and younger patients, the study found very similar rates. They were 61.7% vs 61.7% in those with a TPS ≥50%, and 53.7% vs 54.9% for those with TPS ≥1%.
- The safety profile of pembrolizumab was similar in patients aged ≥75 years and
The analysis was based on individual studies that had excluded elderly who were unfit, so the conclusion may only hold for those in good shape.
Merck Sharp & Dohme Corp.