Background:
Persons ≥65 years represent two-thirds of advanced non-driver mutated NSCLC whereby anti-PD-(L)1 +/- chemotherapy is standard first-line treatment. We evaluate the impact of age on treatment outcomes including immune related adverse events (irAEs) incidence and admission rates at one Australian tertiary centre.
Methods:
Advanced NSCLC patients treated with first-line anti-PD-(L)1 +/- chemotherapy were identified retrospectively via multidisciplinary meeting referral and cross-referenced with electronic medical records. Demographic, treatment outcome and adverse event data was analysed using R-Studio for descriptive statistics and log-binomial models.
Results:
Between Oct 2019-Feb 2022, 278 patients with newly diagnosed NSCLC were identified; n=130 presenting with advanced disease. Of this cohort, n=77 received first-line anti-PD-(L)1 +/- chemotherapy (chemoIO n=63, 82%, IO alone n=14, 18%). Median age was 64yrs (range 36-84) with a higher proportion of older (≥65 years n=48, 62%), non-squamous (n=57, 74%) and ECOG-1 (n=61, 79%) patients. PD-L1 expression was 0% (n=24, 31%), 1-49% (n=28, 36%) and ≥50% (n=24, 31%). Older age was associated with higher rates of hospitalisation for any cause (<65 years 60% vs ≥65 years 76%; RR 1.27, 95% CI 0.89 – 1.82) secondary to admission for febrile neutropenia (n=6 vs n=0), infection (n=9 vs n=5) and irAEs (n=16 vs n=3). Admissions attributed to disease-related symptoms were equal in older vs younger patients (n=9 vs n=9). Older age was associated with higher incidence of any (<65 years 26% vs ≥65 years 54%; RR 2.10, 95% CI 1.05 – 4.18) and grade 3+ (<65 years 29% vs ≥65 years 52%, RR 1.82, 95% CI 0.53 – 6.23) irAEs. The impact of GCSF utilisation, treatment regimen and survival analysis will be presented.
Conclusion:
Patients ≥65 years with advanced NSCLC treated with first-line anti-PD(L)1 +/- chemotherapy are at higher risk of treatment related AEs including hospitalisation for neutropenia, infection and severe irAEs compared to younger patients.