The following is a summary of “Pembrolizumab Alone or With Chemotherapy for 70+ Year-Old Lung Cancer Patients: A Retrospective Study,” published in the November 2023  issue of Pulmonology by Blasi, et al.

First-line pembrolizumab alone, as allowed for PD-L1 ≥50%, or with chemotherapy was looked at in older people with non-small cell lung cancer (NSCLC), for whom there isn’t much evidence. A review was done of 156 patients aged 70 or older treated between January 2016 and May 2021. The radiologic review showed that the tumor was getting worse, and records showed that the treatment was harmful. 

The combination of pembrolizumab and chemotherapy (n = 95) led to more adverse events (91% vs. 51%, P <.001), treatment stopping (37% vs. 21%, P =.034), and hospitalization (56% vs. 23%, P <.001), but the rate of immune-related adverse events (irAEs, mean 35%, P =.998) was the same as with pembrolizumab alone (n = 61). Overall survival (OS) and progression-free survival (PFS) were about the same in both groups (7 vs. 8 months and 16 vs. 14 months, to be exact; P >.25). 

A study done at 12 weeks showed that irAEs were linked to a longer life (median PFS 11 months vs. 5 months, hazard ratio [HR] 0.51, P =.001; median OS 33 months vs. 10 months, HR 0.46, P <.001), but other AEs were not (both P >.35). The shorter PFS and OS were linked to a worse ECOG performance status (PS) of 2 or more, brain metastases at diagnosis, squamous histology, and no tumor PD-L1 expression in a multivariable analysis (HR 1.6–3.9 for PFS and OS, all P <.05). Chemoimmunotherapy raises the risk of side effects and hospitalization without increasing PFS or OS in people aged 70 or older who have been newly diagnosed with NSCLC compared to pembrolizumab alone. ECOG PS 2, brain tumors at diagnosis, squamous histology, and PD-L1 antibodies are all linked to a worse result.

Source: sciencedirect.com/science/article/abs/pii/S1525730423001365