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Home » Despite Rapid Increase in Immunotherapy Use for Lung Cancer, Survival Benefit for Older Patients Is Modest
Over the past decade, the use of immunotherapy to treat advanced non-small cell lung cancer (NSCLC) has increased rapidly, although recent study results have shown that the survival benefits of these therapies have been limited, particularly in elderly patients.
“We found that within a few years after treatments with (immune checkpoint inhibitors) were introduced to the market, more than half of the patients with lung cancer, regardless of their age, received these treatments,” said Dr. Cary P. Gross, Professor of Medicine at the Yale School of Medicine in New Haven, Connecticut, in an interview with CURE®. “But we also found that survival improved significantly in younger patients, but only a minimal change in survival in older individuals. This suggests that we need to investigate more closely whether elderly people really benefit from these compounds.”
“Exciting New Drugs”
According to the introduction to the study, which was published in , there have been over 20 new Food and Drug Administration (FDA) approvals for the treatment of NSCLC
JAMA oncology. This increase in treatment options for patients with NSCLC may have reduced the death rate from lung cancer in the United States
“These are exciting new drugs that have been rapidly incorporated into the treatment of cancer patients,” said Gross. “That applies to all age groups. It is fair to say that checkpoint inhibitors have become a standard of care in lung cancer for patients young and old.”
Gross and colleagues analyzed data from 53,719 patients (mean age 68.5 years) from approximately 280 community-based clinics in the United States. Specifically, these patients had stage 3B, 3C, or 4 NSCLC diagnosed between 2011 and 2019.
“The majority of cancer patients are over 65 years old,” said Gross. “We can think of cancer as an age-related disease in many ways. Therefore, our research team is particularly interested in this group to understand the risks and benefits of new cancer treatments when used in older people.”
The percentage of patients receiving cancer-targeted therapy increased from 69% in 2011 to 77.2% in 2019. After the FDA approved the first immune checkpoint inhibitor to treat NSCLC, the use of these therapies increased 4.7% in 2015 to 45.6%. in 2019. The use of immunotherapy in NSCLC was similar in patients less than 55 years of age and patients 75 years of age in 2019 (45.2% and 43.8%, respectively).
Survival with Immunotherapies
The probability of two-year survival from 2011 to 2018 in patients younger than 55 years increased from 37.7% to 50.3%. in contrast, these rates increased slightly in patients 75 years and older (30.6% vs. 36.2%).
In addition, the median survival time in patients less than 55 years of age increased during the study period (11.5 months to 16 months). In patients aged 75 and over, this increased from 9.1 months to 10.2 months.
“Our study wasn’t designed to answer (why survival gains in elderly patients were modest), but understanding why is critical,” Gross said. “It could be because their overall life expectancy is shorter. This could be because they have a different risk of (side effects) than younger people. Future work is needed, but unless we redesign our research system to focus more on the older patients – the ones who actually take these drugs – we will never know.”
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