Real-world clinical practice for advanced non-small-cell lung cancer in the very elderly: A retrospective multicenter analysis
Real-world clinical practice for advanced non-small-cell lung cancer in the very elderly: A retrospective multicenter analysis
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DOI：
10.1016/j.cllc.2022.05.003
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发表时间：
2022-09-01
影响因子：
3.6
通讯作者：
Soejima, Kenzo
中科院分区：
文献类型：
--
作者：
Fukushima, Takahiro;Oyamada, Yoshitaka;Soejima, Kenzo
本研究旨在探讨80岁及以上晚期非小细胞肺癌患者的治疗方法，以及何种治疗方法可以改善其预后。我们发现，生物标志物匹配的治疗（酪氨酸激酶抑制剂或免疫检查点抑制剂）是有效的，而化疗的有效性，特别是细胞毒性化疗，生物标志物阴性/未知patients.Background：晚期非小细胞肺癌（NSCLC）的最佳治疗非常老年患者是不清楚的。我们的目的是在现实世界的临床实践中评估他们的治疗，并确定可以改善其预后的合适疗法。材料与方法：回顾性分析了在一所大学医院及其9个附属医院入组的132例年龄在80岁及以上的晚期NSCLC日本患者的病历。根据美国东部肿瘤协作组体能状态（ECOG PS）和生物标志物状态比较临床特征和总生存期（OS）。如果程序性死亡配体1肿瘤比例评分（PD-L1 TPS）> 50%或表皮生长因子受体、间变性淋巴瘤激酶或c-ros癌基因1存在激活突变，则将患者定义为生物标志物阳性。最后，在PS 0 - 2和PS 3 - 4患者组中探讨了有助于改善预后的因素。结果：PS 0 - 2患者的中位OS比PS 3 - 4患者更长（5.5 vs 1.6个月）。接受化疗的具有阳性生物标志物的PS 0 - 2患者的中位OS显著长于未接受化疗的患者（18.1 vs. 3.7个月）。在生物标志物阴性/未知PS 0 - 2患者中，接受化疗和未接受化疗的患者的中位OS无显著差异（4.5 vs 3.1个月）。多变量分析显示，在PS 0 - 2组中，酪氨酸激酶抑制剂或免疫检查点抑制剂治疗与更好的预后相关。结论：生物标志物匹配治疗即使在非常高龄的患者中也是有效的。同时，对于生物标志物阴性/未知PS 0 - 2患者，化疗的有效性值得怀疑。(C)2022作者（S）爱思唯尔公司出版
The present study aimed to investigate how advanced NSCLCs in the patients aged 80 and over were treated and what types of therapy can improve their prognosis. We found that biomarker-matched therapy (tyrosine kinase inhibitors or immune checkpoint inhibitors) was effective, while the effectiveness of chemotherapy, especially cytotoxic chemotherapy alone, for biomarker-negative/unknown patients was questionable.Background: The optimal treatment for advanced non-small cell lung cancer (NSCLC) in very elderly patients is unclear. We aimed to evaluate their treatment in real-world clinical practice and identify suitable therapy that can improve their prognosis. Materials and methods: The medical records of 132 Japanese patients aged 80 years and older with advanced NSCLCs who were enrolled at a university hospital and its 9 affiliates were retrospectively analyzed. Clinical characteristics and overall survival (OS) were compared based on the Eastern Cooperative Oncology Group Performance Status (ECOG PS) and biomarker statuses. Patients were defined as biomarker-positive if programmed death-ligand 1 tumor proportion score (PD-L1 TPS) was > 50% or activating mutations were present in epidermal growth factor receptor, anaplastic lymphoma kinase, or c-ros oncogene 1. Finally, the factors contributing to better prognosis were explored in both PS 0 - 2 and PS 3 - 4 patient groups. Results: The PS 0 - 2 patients showed a longer median OS than the PS 3 - 4 patients (5.5 vs. 1.6 months). PS 0 - 2 patients with positive biomarkers who received chemotherapy showed a significantly longer median OS than those without (18.1 vs. 3.7 months). Among the biomarker-negative/unknown PS 0 - 2 patients, the median OS showed no significant difference between those who received chemotherapy and those who did not (4.5 vs. 3.1 months). The multivariate analysis showed that treatment with tyrosine kinase inhibitors or immune checkpoint inhibitors was related to better prognoses in the PS 0 - 2 group. Conclusion: Biomarker-matched therapy is effective even in very elderly patients. Meanwhile, the effectiveness of chemotherapy for biomarker-negative/unknown PS 0 - 2 patients is questionable. (C) 2022 The Author(s). Published by Elsevier Inc.