Among patients with late-stage non-small cell lung cancer (NSCLC), men, smokers, and younger individuals may derive more benefit from immunotherapy, according to a systematic review published in JNCI Cancer Spectrum.

The review authors noted that immunotherapy is the standard of care in NSCLC, but response rates are low. There is a need to identify characteristics that explain variability in immunotherapy efficacy and predict which patients will benefit from the treatment.

“Currently, roughly 50% of patients respond to immunotherapy. There is a need to better understand which patients are less likely to respond, in order to optimize the line of treatment,” said corresponding author Emanuela Taioli, MD, PhD, of Mount Sinai in New York, New York.

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Dr Taioli and colleagues examined how age, smoking status, sex, and race may modify the effectiveness of immunotherapy in late-stage NSCLC. They mined Web of Science, OVID EMBASE, and MEDLINE databases for all studies from 2013 to January 2021 reporting overall survival (OS) or progression-free survival (PFS) for patients with stage IIIB or higher NSCLC, some of whom received immunotherapy.

The researchers reviewed 18 randomized controlled trials (RCTs) comparing immunotherapy (6534 patients) and non-immunotherapy (11,192 patients) groups.

The researchers also analyzed 16 observational studies encompassing 9073 patients who received immunotherapy. For this investigation, results from RCTs and observational studies were deemed complementary because of study design differences.

Factors Linked to Survival

The data showed improved OS or PFS with immunotherapy for men in 10 of 17 RCTs.

Similarly, 10 of 17 RCTs showed improved PFS or OS for patients younger than 65 years. Compared with older patients, younger patients (aged <60, <65, or <70 years in most studies) also had better PFS or OS after immunotherapy in 4 of 13 observational studies.

In addition, smokers had better survival with immunotherapy in 8 of 15 RCTs.

“It is known that smokers are more likely to respond to immunotherapy because their tumors carry more mutations and therefore have more points of attack for immunotherapy. However, a systematic review of the topic gives a more precise quantification of a clinical impression from practice,” Dr Taioli said.

On the other hand, this review provided little evidence on differences in immunotherapy efficacy by race, as only 5 RCTs reported outcomes by this characteristic.