Efficacy and safety of immunotherapy in elderly patients with advanced non-small cell lung cancer: a real-world study stratified by age

This study aimed to evaluate the efficacy and safety of immunotherapy in elderly patients with advanced non-small cell lung cancer (NSCLC), stratified by age. A retrospective analysis included elderly patients (≥ 65 years) diagnosed with stage III–IV NSCLC who received immunotherapy at the PLA General Hospital between January 2016 and October 2024. Participants were stratified into two age groups: <75 years and ≥ 75 years. Propensity score matching (PSM) was applied to balance baseline characteristics, including age, Eastern Cooperative Oncology Group performance status (ECOG PS) score, and treatment line. Primary endpoints were objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and drug safety. Among 535 enrolled patients, the median age was 70 years. The ORR was 54.40% in the group aged < 75 years and 41.75% in the group aged ≥ 75 years. Median overall survival (mOS) was 29.23 months for the < 75 years group and 27.93 months for the ≥ 75 years group. No significant differences were observed between groups in OS (HR = 1.274, P = 0.068) or PFS (HR = 0.907, P = 0.421). The overall incidence of adverse events (AEs) was 90.28%, with no significant differences in AE rates across age groups. Immunotherapy demonstrated feasibility and efficacy in elderly patients with advanced NSCLC. Age did not significantly affect survival outcomes between subgroups (< 75 vs. ≥75 years), and safety was manageable. These findings suggest that the 75-year threshold alone should not preclude treatment; instead, clinical decisions should be guided by a comprehensive geriatric assessment.