Journal of geriatric oncology · 2026
Safety and effectiveness of immune checkpoint inhibitors in older adults with metastatic non-small cell lung cancer and pre-existing autoimmune disease - A SEER-Medicare study.
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Gohil Shrey, Chen Hua, Lewis Whitney E, Trivedi Meghana, Aparasu Rajender R, Johnson Michael L
Аннотация
INTRODUCTION: Immune checkpoint inhibitors (ICIs) have transformed cancer treatment; however, their use in patients with pre-existing autoimmune diseases (PAD) remains controversial. This study evaluated the real-world safety and effectiveness of ICIs in older adults with metastatic non-small cell lung cancer (mNSCLC) and PAD.
MATERIALS AND METHODS: This retrospective cohort study used SEER-Medicare data to investigate individuals aged ≥66 years diagnosed with mNSCLC between 2015 and 2017, receiving either immunotherapy/chemoimmunotherapy (IT/CIT) or chemotherapy (CT). Outcomes were time to hospitalization due to serious immune-related adverse events (irAEs) and overall survival (OS). The treatment effects on outcomes were studied using Cumulative Incidence Function (CIF) plots, Kaplan-Meier curves, the Fine and Gray competing risk regression, and multivariable Cox regression analyses. Adjusted hazard ratios (aHRs) and 95% CIs were reported.
RESULTS: This study involved 1319 older adults with mNSCLC and PAD; 22.3% received IT/CIT and 77.7% received CT. Baseline characteristics differed significantly between treatment groups. No significant difference in serious irAE-related hospitalization was observed between IT/CIT and CT (aHR = 1.06, 95% CI: 0.79-1.42; sensitivity analysis: aHR = 1.01, 95% CI: 0.70-1.45). For OS, among those with pre-existing rheumatoid arthritis (RA), no significant difference was found in the main analysis (aHR = 1.34, 95% CI: 0.94-1.92), though sensitivity analysis indicated higher mortality with IT/CIT (aHR = 1.48, 95% CI: 1.07-2.06). Among those with non-RA PAD, IT/CIT was associated with significantly better OS compared with CT (aHR = 0.77, 95% CI: 0.64-0.91; sensitivity: aHR = 0.71, 95% CI: 0.60-0.84).
DISCUSSION: ICIs may be safe for older adults with PAD with respect to serious irAEs and may confer OS benefits among those with non-RA PAD. However, the less consistent results observed in patients with RA indicate the need for additional studies to more clearly define the effects of ICIs in this subgroup.
MATERIALS AND METHODS: This retrospective cohort study used SEER-Medicare data to investigate individuals aged ≥66 years diagnosed with mNSCLC between 2015 and 2017, receiving either immunotherapy/chemoimmunotherapy (IT/CIT) or chemotherapy (CT). Outcomes were time to hospitalization due to serious immune-related adverse events (irAEs) and overall survival (OS). The treatment effects on outcomes were studied using Cumulative Incidence Function (CIF) plots, Kaplan-Meier curves, the Fine and Gray competing risk regression, and multivariable Cox regression analyses. Adjusted hazard ratios (aHRs) and 95% CIs were reported.
RESULTS: This study involved 1319 older adults with mNSCLC and PAD; 22.3% received IT/CIT and 77.7% received CT. Baseline characteristics differed significantly between treatment groups. No significant difference in serious irAE-related hospitalization was observed between IT/CIT and CT (aHR = 1.06, 95% CI: 0.79-1.42; sensitivity analysis: aHR = 1.01, 95% CI: 0.70-1.45). For OS, among those with pre-existing rheumatoid arthritis (RA), no significant difference was found in the main analysis (aHR = 1.34, 95% CI: 0.94-1.92), though sensitivity analysis indicated higher mortality with IT/CIT (aHR = 1.48, 95% CI: 1.07-2.06). Among those with non-RA PAD, IT/CIT was associated with significantly better OS compared with CT (aHR = 0.77, 95% CI: 0.64-0.91; sensitivity: aHR = 0.71, 95% CI: 0.60-0.84).
DISCUSSION: ICIs may be safe for older adults with PAD with respect to serious irAEs and may confer OS benefits among those with non-RA PAD. However, the less consistent results observed in patients with RA indicate the need for additional studies to more clearly define the effects of ICIs in this subgroup.