Author of

• 31680

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  P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Treatment in the Real World - Support, Survivorship, Systems Research
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31722

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    P2.16-38 - Efficacy and Safety of Target Therapy and Immunotherapy in Advanced NSCLC in Elderly: A Systematic Review of Real World Studies     (ID 2757)

    10:15 - 18:15  |  Author(s): Alessandro Russo
    • Abstract

    Background
    

    Despite notable advances, treatment of advanced non small cell lung cancer (NSCLC) in the elderly remains a challenge.Target therapy and immunotherapy outcomes have been demonstrated in several randomized controlled trials (RCT), however real world setting may closely mirrors everyday clinical practice in elderly population, characterized by poor performance status, significant comorbidities, concomitant treatments, limited adherence and compliance. Systematic review was conducted to examine the published real-world studies evaluating efficacy and safety of target therapy and immunotherapy in elderly patients with advanced NSCLC. These real-world data were compared to those obtained in the phase II and III randomized controlled trials.

    Method
    

    Following PRISMA guidelines, in February 2019 we searched the MEDLINE, Web of Science, and Scopus databases in English language.Titles and abstracts were reviewed by 2 independent reviewers (FT; FV); disagreements were resolved by a third. All identified full papers were assessed independently by three researchers (FT, FV, and AV). Included studies were required to be RWS, and evaluate target therapy or immunotherapy in advanced NSCLC elderly patients. The Newcastle Ottawa Scale (NOS) was used for quality assessment of studies included in the systematic review.

    Result
    

    We found 235 studies through the database, 167 remained after duplicate removal and 24 full-text articles were assessed for eligibility (Figure 1). The systematic search of the literature identified 9 studies meeting the selection criteria to analyse in qualitative synthesis.These studies included a total of 1882 elderly patients mainly treated with first-generation EGFR tyrosine-kinase inhibitors (5 studies), osimertinib only in one study. Bevacizumab in association with chemotherapy was evaluated in two studied. Immunotherapy data was available only in one study. Clinical characteristics of each study population are analyzed. The first relevant aspect is the lack of data on Multidimensional Geriatric Assessment and Charlson Comorbidity Index, that should represent main instruments in clinical practice to personalize therapeutic approach. Heterogeneity of first-generation EGFR TKI efficacy among the studies could be influenced by genetic differences among ethnic groups. In general, the results showed that PFS of patients with advanced NSCLC treated with first-generation EGFR TKI in the real world setting were consistent with those observed in clinical trials, while an inferior survival was recorded. Collected toxicity data were limited.

    

    Conclusion
    

    RWS represent a broad picture of the activity and tolerability of new drugs and can provide interesting observations and research ideas in several settings, particularly in elderly patients, integrating and defining data of the RCTs.