Older patients with advanced non-small cell lung cancer (NSCLC) do not derive the same survival benefit from immune checkpoint inhibitors (ICIs) as younger patients, according to a study published in JAMA Oncology.

The study showed that ICI treatment was associated with clinically meaningful survival gains among patients younger than 55 years but not among patients 75 years or older. 

The researchers looked at data from 53,719 patients treated at 280 US cancer clinics. All patients were 18 years of age or older and had stage IIIB, IIIC, or IV NSCLC. They were diagnosed from 2011 to 2019 and followed through December 2020. 

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Overall, the receipt of any cancer-directed therapy increased from 69.0% in 2011 to 77.2% in 2019 (P <.001). ICI use increased from 4.7% in 2015 (the year of the first ICI approval) to 45.6% in 2019 (P <.001). 

In 2019, the use of ICIs was similar between the patients younger than 55 years of age and patients aged 75 years and older (45.2% and 43.8%, respectively; P = .59).

However, the use of an ICI alone occurred more often in patients 75 years or older, compared with those younger than 55 years (21.4% and 12.7%, respectively; P <.001). The use of ICIs combined with chemotherapy decreased with increasing age. 

From 2015 to 2019, the younger patients had a 4-month improvement in median overall survival, but the median overall survival for older patients improved by less than 1 month.

Among patients younger than 55 years, the median overall survival increased from 14.8 months in 2015 to 19.0 months in 2019 (P =.01). Among patients 75 years or older, the median overall survival increased from 12.3 months in 2015 to 13.0 months in 2019 (P = .02).

“This cohort study found that, among patients with advanced NSCLC, the uptake of ICIs after US Food and Drug Administration approval was rapid across all age groups,” the researchers wrote. “However, corresponding survival gains were modest, particularly in the oldest patients.” 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Voruganti T, Soulos PR, Mamtani R, Presley CJ, Gross CP. Association between age and survival trends in advanced non–small cell lung cancer after adoption of immunotherapy. JAMA Oncol. Published online January 26, 2023. doi:10.1001/jamaoncol.2022.6901