The effectiveness of PD-1 inhibitors in non-small cell lung cancer (NSCLC) patients of different ages
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Yingcheng Wu1,*, Qianqian Ju2,4,*, Bei Qian1,*, Feng Zhang3 and Hui Shi4
1Medical School of Nantong University, Jiangsu 226001, China
2Laboratory Animal Center of Nantong University, Jiangsu 226001, China
3School of Nursing, Nantong University, Jiangsu 226001, China
4Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Jiangsu 226001, China
*These authors contributed equally to this work and shared the co-first authorship
Hui Shi, email: firstname.lastname@example.org
Keywords: PD-1 inhibitor; age; meta-analysis; overall survival; progression-free survival
Received: September 19, 2017 Accepted: December 04, 2017 Published: December 26, 2017
Background: Immunosenescence, the age-related decline of immunity, affects the immune responses of non-small cell lung cancer (NSCLC) patients. Through immune responses, programmed death-1 (PD-1) inhibitors exert their antitumor robustness. In different ages of NSCLC patients, especially the older patients, the effectiveness of PD-1 inhibitors remains unclear. It is still controversial whether pembrolizumab or nivolumab should be used in treating NSCLC patients.
Results: 2,192 NSCLC patients from four phase III RCTs were included. PD-1 inhibitors significantly prolonged the OS in both younger group (<65-year-age) (HR: 0.64, 95% CI: 0.54–0.75, P = 0.000) and older group (≥65-year-age) (HR: 0.68, 95% CI: 0.54–0.81, P = 0.001) than chemotherapy. Among patients aged over 75, no significantly longer OS was observed (HR: 1.02, 95% CI: 0.35–1.69, P = 0.971) than controls. In the older group (≥65-year-age), HR of OS favors nivolumab rather than pembrolizumab.
Conclusions: Among patients aged over 75, no significantly prolonged overall survival was observed compared with chemotherapy. In comparison with pembrolizumab, nivolumab was associated with better OS in older NSCLC patients (≥65-year-age), and better PFS in all NSCLC patients. Older patients, especially those aged over 75, should be paid more attention to in the future clinical trials, guidelines, and clinical practice.
Methods: The authors included clinical trials testing PD-1 inhibitors (nivolumab and pembrolizumab) compared with chemotherapies in older and younger patients. The authors used the hazard ratio (HR) and 95% confidence interval (CI) of overall survival (OS) and progression-free survival (PFS).
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