Drug-eluting transarterial chemoembolization combined with anlotinib for non-small cell lung cancer in the elderly: A multicenter retrospective study.

e20668 Background: Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. Non-small cell lung cancer (NSCLC) accounts for 85% of all new lung cancer cases in the world each year, of which 50% are in the elderly. At present, chemotherapy and radiotherapy are still the main methods for the treatment of advanced lung cancer, but the overall efficacy is limited and the adverse reactions are serious. Drug-eluting transarterial chemoembolization (DE-TACE) is proved to be effective and safe in the treatment of advanced lung cancer. Anlotinib, as a classic anti-angiogenic drug for non-small cell lung cancer, plays an important role in the treatment of non-small cell lung cancer, especially in patients who can not tolerate intravenous chemotherapy, radiotherapy and immunotherapy. This study aims to investigate the safety and effectiveness of drug-eluting transarterial chemoembolization combined with anlotinibof non-small cell lung cancer in the elderly. Methods: Patients with at least 75 years old, refusal or unresectable, driver gene-negative, refusal or inability to tolerate radiotherapy, chemotherapy and immunotherapy, non-small cell lung cancer, were enrolled in this retrospective, multicenter study. (January 2018–December 2023). DE-TACE consisted cisplatin (75 mg/m 2 ) and gemcitabine (600 mg/m 2 ) via feeding arteries and then embolization using drug-eluting beads carrying gemcitabine (400 mg). Anlotinib was administered at a 12 mg/day dose for two consecutive weeks, with a one - week cessation period in - between, forming a single 21 - day treatment cycle. The primary objectives were overall survival (OS) and safety. Overall survival (OS) was analyzed using multivariate COX proportional hazards regression, as well as Kaplan-Meier analysis. Results: The final analysis included 90 patients (median age, 80 years, 74 men). The technical success rate of intratumoral drug delivery was 100%. The median OS was 25.6 months (95% CI 21.1-29.7) and the median PFS was 8.6 months (95% CI 7.8-9.3). In multivariate Cox regression analysis, DE-TACE combined with anlotinib was associated with lower risk of death (HR 1.94, 95% CI 1.04-3.61; log rank test P = 0.037) and lower risk of disease progression (HR 1.87, 95% CI 1.07-3.25; log rank test P = 0.028). Grade 3 or higher treatment-emergent adverse events was 2.2% (2/90). Procedure-related complications included post-embolization syndrome (27.8%; 25/90), chest pain (15.6%; 14/90), access site complication (3.3%; 3/90). No spinal cord injury and cerebral embolism was observed. Conclusions: DE-TACE combined with anlotinib was a technically successful and effective treatment for non-small cell lung cancer in the elderly, with no severe adverse events.