Impact of pembrolizumab on geriatric syndromes in older patients with NSCLC: A propensity-matched retrospective cohort study.

Abstract

12045 Background: Non-small cell lung carcinoma (NSCLC) predominantly affects older adults (≥65 years), where immune checkpoint inhibitors (ICIs) are a key treatment, especially in those without driver mutations. However, the effect of ICIs on age-related health issues (geriatric syndromes), which impact quality of life in this population, is unclear. This study aims to investigate the impact of ICIs on geriatric syndromes in older adults with NSCLC. Methods: We utilized data from the Global Collaborative Network-TrinetX to evaluate the impact of pembrolizumab on geriatric syndromes in elderly NSCLC patients, dividing them into two groups based on pembrolizumab treatment status defined by International Classification of Diseases (ICD-10) codes. Propensity score matching (PSM) was used to balance the cohorts based on demographic characteristics, comorbidities, medications, and without driver mutations. Geriatric syndromes were assessed over 30-day and 1-year follow-up periods. Multivariate logistic regression models assessed the association between pembrolizumab treatment and geriatric syndromes, with results expressed as odds ratios and 95% confidence intervals. Results: Following PSM, there were two balanced cohorts of 3288 patients each. The pembrolizumab cohort had a mean age of 75.6 ± 6.93 years, while the non-pembrolizumab cohort had a mean age of 78.2 ± 7.9 years. Multivariate analysis revealed that pembrolizumab treatment was significantly associated with increased fatigue risk at 30 days (OR 1.600, 95% CI 1.062-2.411, P=0.023), persisting at 1 year (OR 1.769, 95% CI 1.463-2.140, P<0.001). Additionally, pembrolizumab treatment was linked to increased risks of insomnia (OR 1.331, 95% CI 1.052-1.683, P=0.017) and delirium (OR 1.494, 95% CI 1.105-2.019, P=0.009) at 1 year. Notably, pembrolizumab treatment was not significantly associated with risk of dementia, frailty, urinary incontinence, or falls at 30 days and 1 year. Conclusions: Our study shows that pembrolizumab was significantly associated with increased risks of persistent fatigue, delirium, and insomnia in geriatric NSCLC patients at one-year follow-up. This emphasizes the need for monitoring and targeted interventions to mitigate these adverse events and improve quality of life in this population. Geriatric syndromes in NSCLC patients on pembrolizumab. OUTCOME 30 DAYS FOLLOW-UP 1 YEAR FOLLOW-UP OR and 95% CI P-value OR and 95% CI P-value Falls 1.381 (0.631-3.114) 0.434 1.264 (0.946-1.690) 0.113 Dementia 0.993 (0.413 –2.390) 0.988 0.993 (0.581-1.697) 0.980 Delirium 1.400 (0.621-3.156) 0.416 1.494 (1.105-2.019) 0.009 Insomnia 1.656 (0.998-2.748) 0.049 1.331 (1.052-1.683) 0.017 Urinary incontinence N/A* N/A Fatigue 1.600 (1.062-2.411) 0.023 1.769 (1.463-2.140) <0.001 Frailty 1.000 (0.416-2.405) 0.999 1.233 (0.733 –2.073) 0.429 *No outcomes were observed within the follow-up period.