Pembrolizumab Demonstrates Similar Efficacy in Elderly, Younger Patients With Advanced NSCLC: Presented at ELCC

By Jenny Powers

GENEVA -- April 16, 2019 -- Elderly patients with advanced non-small-cell lung cancer (NSCLC) derived the same benefit from immunotherapy as their younger counterparts, researchers reported here at the 2019 European Lung Cancer Conference (ELCC).

In fact older patients treated with pembrolizumab showed higher survival rates and fewer adverse events, reported Kaname Nosaki, MD, National Hospital Organization Kyushu Cancer Centre, Fukuoka, Japan, and colleagues.

Patients aged 75 years and older with confirmed tumour PD-L1 expression (tumour proportion score [TPS] >1%) receiving pembrolizumab demonstrated significantly improved overall survival (OS) compared with patients aged younger than 75 years (hazard ratio [HR] = 0.76; 95% confidence interval [CI], 0.56-1.02).

The 1-year OS rates with pembrolizumab in elderly versus younger patients were comparable (53.7% vs 54.9%)

Among patients with high PD-L expression, the 1-year OS rate was 61.7% in both the elderly group and the younger cohort.

Improved OS was also observed in elderly patients with PD-L1 TPS >50% receiving first-line pembrolizumab compared with younger patients (HR = 0.41; 95% CI, 0.23-0.73).

The researchers used data from KEYNOTE-010, KEYNOTE-024, and KEYNOTE-042 to compare the efficacy and safety results of 264 patients aged 75 years and older with 2,292 patients aged younger than 75 years.

All 3 studies enrolled patients with advanced NSCLC and PD-L1 TPS ≥1%; KEYNOTE-024 enrolled patients with TPS ≥50%. In KEYNOTE-010, patients received pembrolizumab 2 or 10 mg/kg every 3 weeks or docetaxel, as second- or later-line therapy. In KEYNOTE-024 and KEYNOTE-042, patients received first-line pembrolizumab 200 mg every 3 weeks or platinum-based chemotherapy.

The most common grade ≥3 adverse events (AEs) with pembrolizumab in elderly patients were fatigue (17.4%), decreased appetite (12.8%), and pruritus (12.8%).

Although immune-mediated AEs and infusion reactions were more frequent with pembrolizumab compared with chemotherapy in the elderly group of patients (25% vs 7%), there was no difference between the elderly and younger patients in the incidence of immune-mediated AEs.

Treatment discontinuation due to an AE was reported in 16 patients each on pembrolizumab and chemotherapy in the elderly group versus 90 and 93 patients in the younger group.

Two elderly patients -- 1 in the pembrolizumab group and 1 in the chemotherapy group -- died due to an AE, compared with 19 (17 on pembrolizumab, 2 on chemotherapy) patients in the younger group.

“Our data support the use of pembrolizumab monotherapy in elderly patients aged ≥75 years with advanced PD L1-expressing NSCLC,” said Dr. Nosaki.

He noted that in the real world, PD-L1 status is often unknown, therefore, these data may not reflect actual pembrolizumab results in the clinical setting.

Funding for this study was provided by Merck Sharp & Dohme Corp.

[Presentation title: Safety and Efficacy of Pembrolizumab (Pembro) Monotherapy in Elderly Patients (Pts) With PD-L1-Positive Advanced NSCLC: Pooled Analysis From KEYNOTE-010, -024, and -042. Abstract 103OPR]

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