Treatment at Twilight: An Analysis of Therapy Patterns and Outcomes in Adults 80 Years and Older With Advanced or Metastatic NSCLC

Introduction: The aim of this study is to evaluate treatment patterns, survival outcomes, and factors influencing systemic treatment decisions in adults 80 years and older with NSCLC. Methods: This was a retrospective National Cancer Database study evaluating outcomes in adults aged 80 years and older with advanced NSCLC. Patients were analyzed on the basis of systemic therapy, including none, chemotherapy or immunotherapy (IO) alone, and chemotherapy plus IO (chemotherapy + IO). Median overall survival (OS) was compared using Kaplan-Meier methodology. Hazard ratio with 95% confidence interval (CI) was used to assess differences in outcomes, and OR with 95% CI was used to assess factors contributing to systemic therapy provision. Results: Patients 80 years and older (OR = 1.135 [95% CI: 1.127–1.142], p = 0.000), females (OR = 1.129 [95% CI: 1.085–1.175], p < 0.001), blacks (OR = 1.272 [95% CI: 1.179–1.372], p < 0.001), non-Hispanic whites (OR = 1.210 [95% CI: 1.075–1.362], p = 0.002), and those with increasing Charlson-Deyo Comorbidity Index score (p < 0.001) were less likely to receive systemic therapy. Median OS for no therapy, IO alone, chemotherapy alone, and chemotherapy plus IO was 2.63 (95% CI: 2.57–2.69), 10.68 (95% CI: 9.96–11.39), 12.35 (95% CI: 11.98–12.72), and 14.03 (95% CI: 13.87–14.88) months, respectively. In chemotherapy alone, mean OS was 1.12 months (95% CI: 0.55–1.70) (p < 0.001) longer with multiagent versus single agent. There was no difference between IO plus single agent versus IO plus multiagent chemotherapy (0.67 mo [95% CI −1.18 to 2.54], p = 1.00). Conclusions: Age, comorbidities, patient race, and sex affected systemic therapy provision. Multiagent chemotherapy and chemotherapy plus IO significantly improved survival; with the latter, survival was similar with IO plus single or multiagent chemotherapy.