Despite Rapid Increase in Immunotherapy Use for Lung Cancer, Survival Benefit for Older Patients Is Modest

Over the past decade, the use of immunotherapy as treatment for advanced non-small cell lung cancer (NSCLC) has increased rapidly, although survival benefits from these therapies have been limited, especially in older patients, according to recent study findings.

“We found that within a couple years of the introduction of (immune checkpoint inhibitor) treatments into the market, over half of patients with lung cancer were getting these treatments regardless of their age,” said Dr. Cary P. Gross, professor of medicine at Yale School of Medicine in New Haven, Connecticut, in an interview with CURE®. “But we also found that while survival improved in younger patients in a substantial way, in older persons, there was only a minimal change in survival. This suggests that we need to look more closely at whether older people are truly benefiting from these agents.”

‘Exciting New Medicines’

There have been over 20 new Food and Drug Administration (FDA) approvals for the treatment of NSCLC, according to the introduction of the study published in JAMA Oncology. This increase in treatment options for patients with NSCLC may have potentially decreased the rate of lung cancer deaths in the U.S.

“These are exciting new medicines, and they have been rapidly adopted into the care of patients with cancer,” Gross said. “This is true for all age groups. It’s fair to say that checkpoint inhibitors have become a standard of lung cancer care for young and old patients alike.”

Gross and colleagues analyzed data from 53,719 patients (mean age, 68.5 years) from approximately 280 community-based clinics in the U.S. In particular, these patients had stage 3B, 3C or 4 NSCLC that was diagnose between 2011 and 2019.

“The majority of patients with cancer are over the age of 65 years,” Gross said. “We can think about cancer as an aging-related disease in many ways. That is why our research team is particularly interested in this group, in understanding the risks and benefits of new cancer treatments when they are used in older people.”

The percentage of patients receiving cancer-directed therapy increased from 69% in 2011 to 77.2% in 2019. After the FDA approved the first immune checkpoint inhibitor for the treatment of NSCLC, the use of these therapies increased from 4.7% in 2015 to 45.6% in 2019. The use of immunotherapy for NSCLC was similar in 2019 between patients younger than 55 years and those aged 75 years (45.2% versus 43.8%, respectively).

Survival With Immunotherapies

The probability of two-year survival from 2011 to 2018 in patients younger than 55 years old increased from 37.7% to 50.3%. in contrast, these rates modestly increased in patients 75 years and older (30.6% versus 36.2%).

In addition, the median survival in patients younger than 55 years increased during the study period (11.5 months to 16 months). For patients 75 years and older, this increased from 9.1 months to 10.2 months.

“Our study wasn’t designed to answer (why survival gains were modest in older patients), but it’s crucial to understand why,” Gross said. “It could be because their overall life expectancy is shorter. It could be because they have a different risk of (side effects) than younger people. Future work is needed, but unless we redesign our system of research to focus more on the older patients — the ones who are actually taking these medications — we’ll never know.”

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