文章：

一线帕博利珠单抗单药治疗在年龄≥70岁且PD-L1高表达（TPS≥50%）的转移性非小细胞肺癌患者中的疗效：一项多中心真实世界研究

The Efficacy of First-Line Pembrolizumab Monotherapy in Patients with Metastatic NSCLC Aged ≥70 Years with High PD-L1 (TPS ≥ 50%) Expression: A Multicenter Real-World Study

原文发布日期：28 June 2025

DOI: 10.3390/cancers17132190

类型: Article

开放获取: 是

英文摘要：

Introduction:Elderly patients with metastatic non-small-cell lung cancer (NSCLC) are underrepresented in clinical trials evaluating immune checkpoint inhibitors (ICIs). This study assesses the efficacy of first-line pembrolizumab monotherapy in patients with metastatic NSCLC aged ≥70 years with a programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) ≥ 50%.Materials and Methods:We retrospectively analyzed 381 patients with metastatic NSCLC without oncogenic driver mutations treated with pembrolizumab monotherapy between 2017 and 2023 at three academic centers in Central and Southeastern Europe. Clinical outcomes, including median time on treatment (mToT) and overall survival (mOS), were compared between patients aged ≥70 and <70 years.Results:Of 381 patients, 149 (39.1%) were aged ≥70. No significant differences in mToT (12.7 vs. 14.3 months;p= 0.125) or mOS (18.2 vs. 27.4 months;p= 0.124) were observed between older and younger groups. Good ECOG PS (0–1) was independently associated with longer mToT and mOS in older patients. Additionally, a history of smoking was linked to improved outcomes compared to never-smokers, suggesting potential immunogenic effects. Older patients were significantly less likely to receive second-line therapy after progression (p= 0.04).Conclusions:First-line pembrolizumab monotherapy is effective across all age groups and provides similar treatment efficacy in patients with metastatic NSCLC and a PD-L1 TPS ≥ 50%. Patients older than 70 with a smoking history and ECOG PS 0–1 derive the most benefit from this treatment modality. The adaptation of this treatment strategy for elderly patients is especially important, since only a minority of them are capable of receiving second-line therapy.

摘要翻译： 

引言：在评估免疫检查点抑制剂（ICIs）的临床试验中，老年转移性非小细胞肺癌（NSCLC）患者的代表性不足。本研究评估了程序性死亡配体-1（PD-L1）肿瘤比例评分（TPS）≥50%、年龄≥70岁的转移性NSCLC患者一线帕博利珠单抗单药治疗的疗效。 材料与方法：我们回顾性分析了2017年至2023年间在中欧和东南欧三个学术中心接受帕博利珠单抗单药治疗的381例无致癌驱动基因突变的转移性NSCLC患者。比较了年龄≥70岁与<70岁患者的临床结局，包括中位治疗时间（mToT）和总生存期（mOS）。 结果：在381例患者中，149例（39.1%）年龄≥70岁。老年组与年轻组在mToT（12.7个月 vs. 14.3个月；p=0.125）或mOS（18.2个月 vs. 27.4个月；p=0.124）方面均未观察到显著差异。在老年患者中，良好的ECOG PS（0-1分）与更长的mToT和mOS独立相关。此外，与从不吸烟者相比，有吸烟史的患者结局有所改善，提示了潜在的免疫原性效应。老年患者在疾病进展后接受二线治疗的可能性显著更低（p=0.04）。 结论：一线帕博利珠单抗单药治疗在所有年龄组中均有效，对PD-L1 TPS ≥50%的转移性NSCLC患者提供了相似的治疗效果。年龄超过70岁、有吸烟史且ECOG PS为0-1分的患者从此治疗模式中获益最大。为老年患者调整此治疗策略尤为重要，因为他们中仅有少数能够接受二线治疗。

原文链接：

The Efficacy of First-Line Pembrolizumab Monotherapy in Patients with Metastatic NSCLC Aged ≥70 Years with High PD-L1 (TPS ≥ 50%) Expression: A Multicenter Real-World Study