BACKGROUND Limited data exist regarding the characteristics and survival outcomes of older adults with non-small cell lung cancer (NSCLC) who receive immune checkpoint inhibitors in routine oncology practice. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 1256 patients aged ≥65 years who were diagnosed with pathologically confirmed stage I to stage IV NSCLC between 2002 and 2015 and initiated nivolumab or pembrolizumab in 2016. We examined patient characteristics and overall survival from the time of immune checkpoint inhibitor initiation through December 31, 2017. RESULTS The median patient age at the time of immune checkpoint inhibitor initiatiton was 75.3 years (interquartile range, 8.5). A substantial percentage of patients were initially diagnosed with stage IV disease (42.6%) and had ≥2 comorbid conditions (48.7%). Using a claims-based proxy, 11.5% of patients had poor performance status and 12.6% had a history of autoimmune conditions. The median overall survival after initiation of immune checkpoint inhibitor was 9.3 months (95% CI, 8.5-10.5 months). The 1-year survival rate was 43.0% (95% CI, 40.2-45.7%). In multivariable analyses, multiple comorbid conditions, squamous histology, a history of nonplatinum doublet systemic therapy, recent radiotherapy, and a shorter time from initial diagnosis to treatment initiation were found to be statistically significantly associated with an increased hazard of death. Demographics, poor performance status, and prior autoimmune conditions were not significantly associated with the hazard of death. CONCLUSIONS Many older adults with NSCLC who initiated immune checkpoint inhibitors had multiple comorbidities, a history of autoimmune disease, or poor performance status. Factors associated with poor prognosis among patients with advanced NSCLC were also associated with worse survival in older adults treated with immune checkpoint inhibitors.

中文翻译：

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免疫检查点抑制剂在患有非小细胞肺癌的老年人中的真实使用和生存结果。

背景 关于在常规肿瘤学实践中接受免疫检查点抑制剂治疗的老年非小细胞肺癌 (NSCLC) 患者的特征和生存结果的数据有限。方法 使用监测、流行病学和最终结果-医疗保险链接数据库，我们确定了 1256 名年龄≥65 岁的患者，这些患者在 2002 年至 2015 年间被诊断为经病理证实的 I 期至 IV 期 NSCLC，并于 2016 年开始使用纳武单抗或派姆单抗。我们检查了患者从免疫检查点抑制剂启动时到 2017 年 12 月 31 日的特征和总生存期。结果 免疫检查点抑制剂启动时患者的中位年龄为 75.3 岁（四分位间距，8.5）。相当大比例的患者最初被诊断为 IV 期疾病 (42. 6%) 并有≥2 种合并症 (48.7%)。使用基于索赔的代理，11.5% 的患者表现状态不佳，12.6% 的患者有自身免疫性疾病史。开始使用免疫检查点抑制剂后的中位总生存期为 9.3 个月（95% CI，8.5-10.5 个月）。1 年生存率为 43.0%（95% CI，40.2-45.7%）。在多变量分析中，发现多种合并症、鳞状组织学、非铂双药全身治疗史、近期放疗以及从初步诊断到治疗开始的较短时间与死亡风险增加在统计学上显着相关。人口统计学、身体状况不佳和先前的自身免疫性疾病与死亡风险没有显着相关性。结论 许多启动免疫检查点抑制剂治疗的 NSCLC 老年患者有多种合并症、自身免疫性疾病病史或身体状况不佳。与晚期 NSCLC 患者预后不良相关的因素也与接受免疫检查点抑制剂治疗的老年人生存期较差有关。