Real-world comparison of chemoimmunotherapy and chemotherapy alone in elderly patients (≥75 years) with extensive-stage small cell lung Cancer

Introduction Given the underrepresentation of adults aged ≥75 years with extensive-stage small-cell lung cancer (ES-SCLC) in clinical trials, we compared first-line chemoimmunotherapy versus chemotherapy in this population.Methods This retrospective study enrolled 88 patients aged ≥75 years with ES-SCLC treated with either chemotherapy alone (n = 42) or chemoimmunotherapy (n = 46). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS) and safety. Multivariable Cox regression and stabilized inverse probability of treatment weighting (IPTW) analyses were performed to reduce confounding.Results Median OS and PFS were 14.3 (95% CI: 11.6–22.5) and 6.6 in the chemotherapy group and 16.9 (95% CI: 12.7–NA) and 7.6 months in the chemoimmunotherapy group, respectively (HR: 0.90, 95% CI: 0.51–1.58, p = 0.71; HR: 0.75, 95% CI: 0.43–1.29, p = 0.30, respectively). Multivariate analysis identified smoking status as an independent predictor of OS (HR: 2.10, 95% CI: 1.01–4.38, p = 0.048).Conclusion Among patients aged ≥75 years with ES-SCLC, chemoimmunotherapy was associated with numerically longer OS compared with chemotherapy alone, although this difference did not reach statistical significance.