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. 2023 Mar 1;9(3):334-341.
doi: 10.1001/jamaoncol.2022.6901.

Association Between Age and Survival Trends in Advanced Non-Small Cell Lung Cancer After Adoption of Immunotherapy

Teja Voruganti  1 , Pamela R Soulos  2 , Ronac Mamtani  3 , Carolyn J Presley  4 , Cary P Gross  2   5
Affiliations

Association Between Age and Survival Trends in Advanced Non-Small Cell Lung Cancer After Adoption of Immunotherapy

Teja Voruganti et al. JAMA Oncol. .

Abstract

Importance: The introduction of immune checkpoint inhibitors (ICIs) has transformed the care of advanced non-small cell lung cancer (NSCLC). Although clinical trials suggest substantial survival benefits, it is unclear how outcomes have changed in clinical practice.

Objective: To assess temporal trends in ICI use and survival among patients with advanced NSCLC across age strata.

Design, setting, and participants: This cohort study was performed in approximately 280 predominantly community-based US cancer clinics and included patients aged 18 years or older who had stage IIIB, IIIC, or IV NSCLC diagnosed between January 1, 2011, and December 31, 2019, with follow-up through December 31, 2020. Data were analyzed April 1, 2021, to October 19, 2022.

Main outcomes and measures: Median overall survival and 2-year survival probability. The predicted probability of 2-year survival was calculated using a mixed-effects logit model adjusting for demographic and clinical characteristics.

Results: The study sample included 53 719 patients (mean [SD] age, 68.5 [9.3] years; 28 374 men [52.8%]), the majority of whom were White individuals (36 316 [67.6%]). The overall receipt of cancer-directed therapy increased from 69.0% in 2011 to 77.2% in 2019. After the first US Food and Drug Administration approval of an ICI for NSCLC, the use of ICIs increased from 4.7% in 2015 to 45.6% in 2019 (P < .001). Use of ICIs in 2019 was similar between the youngest and oldest patients (aged <55 years, 45.2% vs aged ≥75 years, 43.8%; P = .59). From 2011 to 2018, the predicted probability of 2-year survival increased from 37.7% to 50.3% among patients younger than 55 years and from 30.6% to 36.2% in patients 75 years or older (P < .001). Similarly, median survival in patients younger than 55 years increased from 11.5 months to 16.0 months during the study period, while survival among patients 75 years or older increased from 9.1 months in 2011 to 10.2 months in 2019.

Conclusions and relevance: 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. However, corresponding survival gains were modest, particularly in the oldest patients.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Soulos reported receiving personal fees from Target PharmaSolutions (now Target RWE) outside the submitted work. Dr Mamtani reported receiving grants from Merck and Astellas Pharma and personal fees from Flatiron Health, Seagen, Astellas Pharma, and Bristol Myers Squibb outside the submitted work. Dr Gross reported receiving grants from Johnson & Johnson and the National Comprehensive Cancer Network (AstraZeneca) and personal fees from Genentech outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patients Receiving Treatment by Year of Diagnosis and by Age Group
Figure 2.
Figure 2.. Median Overall Survival by Year of Diagnosis and Age Group
The vertical line at 2015 denotes the first approval of an immune checkpoint inhibitor by the US Food and Drug Administration. NSCLC indicates non–small cell lung cancer.
Figure 3.
Figure 3.. Predicted Probability of 2-Year Survival by Year of Diagnosis and Age Group
Probability was adjusted for sex, race and ethnicity, smoking status, geographic region, stage at initial diagnosis, insurance type, and histological subtype. Error bars represent 95% CIs.
Figure 4.
Figure 4.. Treatment Patterns and Predicted Probability of 2-Year Survival by Age Group
The patients included were receiving an immune checkpoint inhibitor (ICI) in 2017 and 2018.
See this image and copyright information in PMC

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