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. 2021 Mar 17:14:1961-1968.
doi: 10.2147/OTT.S301500. eCollection 2021.

Anti-PD-1 Monotherapy for Advanced NSCLC Patients with Older Age or Those with Poor Performance Status

Taichi Matsubara  1 , Takashi Seto  1 , Shinkichi Takamori  1 , Takatoshi Fujishita  1 , Ryo Toyozawa  1 , Kensaku Ito  1 , Masafumi Yamaguchi  1 , Tatsuro Okamoto  1
Affiliations

Anti-PD-1 Monotherapy for Advanced NSCLC Patients with Older Age or Those with Poor Performance Status

Taichi Matsubara et al. Onco Targets Ther. .

Abstract

Purpose: Anti-programmed death 1 (PD-1) antibodies have emerged as frontline treatments for patients with advanced non-small cell lung cancer (NSCLC) on the basis of global Phase III trials. However, current data regarding responses to anti-PD-1 therapy in older patients with NSCLC or those with poor performance status (PS) are limited. Therefore, we examined the therapeutic effect of anti PD-1 antibody in these patients.

Patients: We retrospectively examined consecutive patients treated with anti-PD-1 monotherapy (pembrolizumab or nivolumab) from January 2016 to September 2018.

Results: We enrolled 125 patients (median age, 60 years), 80.8% of whom were men. Patients aged ≥75 years were considered older patients (n = 15), and those with PS 2-3 were regarded as having poor PS (n = 11). The objective response and disease control rates were 15.4% and 46.2%, respectively, in older patients and 9.1% and 27.3%, respectively, in those with poor PS. Progression-free survival (PFS) and overall survival (OS) did not significantly differ between older and younger patients. However, poor PS was significantly associated with poor survival. High programmed death ligand 1 (PD-L1) expression in tumor specimens (≥50%) was associated with favorable survival in the entire cohort as well as patients with poor PS. Safety analyses demonstrated no significant difference in the occurrence of any adverse event, including grade ≥3 adverse events, between patients with poor PS or older age and the remaining patients.

Conclusion: Anti-PD-1 therapy had similar efficacy in older and younger patients with NSCLC, whereas survival was significantly worse in patients with poor PS. However, immune checkpoint inhibitors may be considered for patients with poor PS harboring positive PD-L1 expression.

Keywords: immunotherapy; lung cancer; non-small cell lung cancer; prognosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Therapeutic response in older patients treated with immune checkpoint inhibitors. (B) Therapeutic response in patients with poor performance status treated with immune checkpoint inhibitors.
Figure 2
Figure 2
Kaplan–Meier curves for progression-free survival (A) and overall survival (B) among older and younger patients treated with immune checkpoint inhibitors. Kaplan–Meier curves for progression–free survival (C) and overall survival (D) among patients with performance status (PS) 0–1 or 2–3.
Figure 3
Figure 3
Overall survival following treatment with immune checkpoint inhibitors according to tumor programmed death ligand 1 (PD-L1) expression (the cut-off values of PD-L1 expression were (A) 50% and (B) 1%, respectively), and subgroup analysis of patients with poor performance status according to tumor PD-L1 expression (the cut-off values of PD-L1 expression were (C) 50% and (D) 1%, respectively). Patients lacking PD-L1 data were excluded in these analyses.
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