Use of PD-1/PD-L1 inhibitors in non-small cell lung cancer in elderly patients: A meta-analysis.

Abstract

e20558 Background: Non-small cell lung cancer (NSCLC) is considered a significant health concern due to its high prevalence and frequently diagnosed at an advanced stage, making treatment challenging. The use of immune checkpoint inhibitors targeting PD-1/PD-L1 pathways has transformed the intervention scenario, offering improved survival outcomes compared to traditional therapies. Even so, elderly patients are often underrepresented in clinical trials, raising concerns about the efficacy in this population. Methods: PubMed, Web of Science and Scopus library were searched for randomized clinical trials and observational longitudinal studies comparing the use of PD-1/PD-L1 inhibitors with placebo and/or chemotherapy in elderly patients (>60 years) with non-small cell lung cancer. Overall survival (OS) and Event-Free Survival (EFS) were the endpoints evaluated. Pooled estimates were calculated using a random-effects model with 95% confidence interval (CI). Statistical analysis was conducted through R software 4.3.1. Results: 13 RCT’s with 7228 patients were included, of whom 4054 used PD-1/PD-L1 inhibitors and 3174 received placebo and/or chemotherapy. A total of 3441 patients were aged 60 or older. 5278 men and 1950 women were included in this study. About histological features, 2600 patients had squamous differentiation and 3951 were classified as non-squamous. 340 patients were diagnosed with brain metastasis. The results indicated a significant association between EFS and use of PD-1/PD-L1 inhibitors with a pooled hazard ratio of 0.64 (95% CI: [0.51-0.79]; P < 0.001). A statistically significant improvement in OS was observed in favor of the use of PD-1/PD-L1 inhibitors (HR 0.76; 95% CI: 0.69-0.84; P < 0.001). Conclusions: Our meta-analysis suggests that PD-1/PD-L1 inhibitors significantly improve clinical outcomes, including EFS and OS, in elderly patients with NSCLC compared to chemotherapy.