Immunotherapy and overall survival among older patients with advanced non-small cell lung cancer

Older patients represent the majority of patients with advanced non-small cell lung cancer (NSCLC) but remain under-represented in clinical trials of immune-checkpoint inhibitor (ICI) therapy, leaving the optimal age-specific first-line treatment uncertain. To assess whether the survival benefit of first-line ICI therapy compared to conventional chemotherapy demonstrated in clinical trials extends to older patients with advanced NSCLC in clinical practice. This retrospective cohort study analyzed administrative claims data from Japan between December 2015 and January 2023. To assess whether age modifies the association between immunotherapy as a first-line therapy compared to conventional chemotherapy and overall survival in patients with advanced NSCLC, we conducted multivariable Cox proportional hazards regression treating age as a continuous variable. Among 35,953 patients with advanced NSCLC, 14,560 received ICI therapy (mean [standard deviation] age, 70.3 [9.2] years; 11,669 [80.1%] males), and 21,393 received conventional chemotherapy (mean [standard deviation] age, 70.2 [9.0] years; 16,098 [75.2%] males). ICI therapy was associated with a lower mortality risk than conventional chemotherapy across the examined age range (50–85 years). This association was more pronounced in patients aged <60 and >70 years, while the difference was less marked in those aged 60–70 years. Our real-world findings suggest that the survival benefit of ICI therapy demonstrated in clinical trials may extend to older patients with advanced NSCLC. Additionally, the fact that the association between immunotherapy and lower mortality risk varies across ages 50–85 years highlights the importance of age-specific assessments for individualized treatment strategies.