Efficacy and safety of low-intensity chemotherapy combined with immunotherapy in elderly patients with locally advanced and metastatic non–small cell lung cancer: a retrospective analysis

For advanced non-small cell lung cancer (NSCLC) lacking driver mutations, immunotherapy combined with chemotherapy is a standard treatment; however, elderly patients frequently exhibit poor tolerance to standard chemotherapy and derive limited benefit from immunotherapy alone. Thus, this retrospective study assessed the efficacy and safety of low-intensity chemotherapy combined with immunotherapy in elderly (≥ 65) patients with locally advanced and metastatic NSCLC. We included 554 patients from the PLA General Hospital who were divided into three cohorts: immune monotherapy (monotherapy group, n = 125), a combination of immunotherapy and standard chemotherapy (standard group, n = 205), and immunotherapy paired with low-intensity chemotherapy (low-intensity group, n = 224). The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoints included the objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Compared with the monotherapy group, the low-intensity group demonstrated significantly improved median PFS (11.50 vs. 7.87 months, P < 0.001) and OS (32.20 vs. 14.97 months, P < 0.001). The inverse probability of treatment weighting (IPTW) adjustment sustained these benefits. Compared with the standard group, the low-intensity group had similar PFS and OS rates, and better safety profiles. This study indicates that low-intensity chemoimmunotherapy is superior to immune monotherapy and offers a safer alternative to standard chemoimmunotherapy in elderly NSCLC patients, suggesting its potential as a first-line treatment.