Chemoimmunotherapy Combinations in Elderly Patients with Metastatic Non-Small Cell Lung Cancer and PD-L1 Expression < 50%: Results from an Italian Real-World Study

<b>Background:</b> Chemoimmunotherapy combinations represent the standard first-line treatment for non-oncogene addicted metastatic NSCLC (mNSCLC). However, evidence in elderly patients remains limited and conflicting. We conducted an analysis of the efficacy and safety of chemoimmunotherapy in patients aged ≥75 years enrolled in the Real-Combo Lung study, an observational study including patients with non-oncogene-addicted mNSCLC and PD-L1 expression < 50%. <b>Patients and Methods:</b> The primary objective of the study was to compare progression-free survival (PFS) and overall survival (OS) between patients aged ≥75 (elderly cohort) and those aged <75 years (non-elderly cohort). Safety outcomes were evaluated as a secondary objective. <b>Results:</b> A total of 495 patients were enrolled, with 89 (18%) aged ≥75 and 406 (82%) aged <75 years. No significant differences in PFS and OS were observed between the two cohorts. The median PFS was 13.3 months (95% CI: 9.3-NR) in the elderly cohort and 10.5 months (95% CI: 9.5-12.9) in the non-elderly cohort (unadjusted HR 0.84, 95% CI: 0.61-1.16, <i>p</i> = 0.29). The median OS was 17.5 months (95% CI: 14.7-NR) versus 21.4 months (95% CI: 17-NR), respectively (unadjusted HR 1.09, 95% CI: 0.76-1.56, <i>p</i> = 0.63). In multivariable analysis, ECOG PS ≥ 2 and baseline use of steroids were significantly associated with a worse outcome in the elderly cohort for both PFS and OS. Safety data did not differ significantly between cohorts. <b>Conclusions:</b> In this real-world study, elderly patients with mNSCLC derived outcomes comparable to those of younger patients, with similar efficacy and a manageable safety profile when treated with chemoimmunotherapy combinations.

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Journal
Journal of Clinical Medicine
Published
2026-02-02
DOI
https://doi.org/10.3390/jcm15031165
Primary Topic
Cancer Immunotherapy and Biomarkers
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article
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article

Chemoimmunotherapy Combinations in Elderly Patients with Metastatic Non-Small Cell Lung Cancer and PD-L1 Expression < 50%: Results from an Italian Real-World Study

M. Russano, Emanuela Vattemi, Floriana Morgillo, Stefania Gori et al.
Journal of Clinical Medicine
Cancer Immunotherapy and Biomarkers
article

Chemoimmunotherapy Combinations in Elderly Patients with Metastatic Non-Small Cell Lung Cancer and PD-L1 Expression < 50%: Results from an Italian Real-World Study

M. Russano, Emanuela Vattemi, Floriana Morgillo, Stefania Gori, Elio Gregory Pizzutilo, Mariachiara Dipasquale, Anthony DelConte, Marina Gilli, Daniele Piscazzi, Clementina Savastano, C Genova, O. Caffo, Giuseppe Azzarello, Francesco Verderame, Antonello Veccia, Alessandro Scala, Fabiana Vitiello, Giovanni Palazzolo, Cristina Mazzi, Alberto Pavan, Eleonora Gariazzo, Alessandra Dessì, Fiorella Lombardo, Rita Chiari, Carminia Maria Della Corte, Simona Busato, Ettore D’Argento, Antonella Cristofano, Daniela Bencardino, Emilio Bria, Daniele Galanti, Alessandro Inno, Alessandro Morabito
article en

Abstract

<b>Background:</b> Chemoimmunotherapy combinations represent the standard first-line treatment for non-oncogene addicted metastatic NSCLC (mNSCLC). However, evidence in elderly patients remains limited and conflicting. We conducted an analysis of the efficacy and safety of chemoimmunotherapy in patients aged ≥75 years enrolled in the Real-Combo Lung study, an observational study including patients with non-oncogene-addicted mNSCLC and PD-L1 expression < 50%. <b>Patients and Methods:</b> The primary objective of the study was to compare progression-free survival (PFS) and overall survival (OS) between patients aged ≥75 (elderly cohort) and those aged <75 years (non-elderly cohort). Safety outcomes were evaluated as a secondary objective. <b>Results:</b> A total of 495 patients were enrolled, with 89 (18%) aged ≥75 and 406 (82%) aged <75 years. No significant differences in PFS and OS were observed between the two cohorts. The median PFS was 13.3 months (95% CI: 9.3-NR) in the elderly cohort and 10.5 months (95% CI: 9.5-12.9) in the non-elderly cohort (unadjusted HR 0.84, 95% CI: 0.61-1.16, <i>p</i> = 0.29). The median OS was 17.5 months (95% CI: 14.7-NR) versus 21.4 months (95% CI: 17-NR), respectively (unadjusted HR 1.09, 95% CI: 0.76-1.56, <i>p</i> = 0.63). In multivariable analysis, ECOG PS ≥ 2 and baseline use of steroids were significantly associated with a worse outcome in the elderly cohort for both PFS and OS. Safety data did not differ significantly between cohorts. <b>Conclusions:</b> In this real-world study, elderly patients with mNSCLC derived outcomes comparable to those of younger patients, with similar efficacy and a manageable safety profile when treated with chemoimmunotherapy combinations.

Journal of Clinical MedicineVol. 15(3)
Università Cattolica del Sacro Cuore (IT), University of Perugia (IT), Agostino Gemelli University Polyclinic (IT), Ospedale Santa Chiara (IT), Azienda Ospedaliera di Perugia (IT), Ospedale di Bolzano (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Ospedale Vincenzo Cervello (IT), Ospedale Sacro Cuore Don Calabria (IT), Casa di Cura Villa Garda (IT), Ospedale Santa Maria (IT), University of Campania "Luigi Vanvitelli" (IT), Centro di Riferimento Oncologico (IT), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Ospedale di Mirano (IT), Ospedale Monaldi (IT), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Campus Bio Medico University Hospital (IT), Ospedale Generale Regionale Francesco Miulli (IT), Ospedale dell' Angelo (IT), Ospedale Policlinico San Martino (IT), Casa di Cura Città di Roma (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Ospedale Buccheri la Ferla Fatebenefratelli (IT), Azienda Ospedaliera G. Brotzu (IT), University of Genoa (IT)
Good health and well-being
Openalex Percentile: Top 70%
Cancer Immunotherapy and Biomarkers
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