Neoadjuvant immunotherapy in geriatric patients with non-small cell lung cancer: A real-world analysis.
- 1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
Abstract
Objectives
Neoadjuvant immunotherapy has been shown to significantly improve survival in patients with stage IB-IIIB non-small cell lung cancer. However, it is unknown whether geriatric patients experience similar benefits. Using a large national cohort, we studied outcomes of neoadjuvant immunotherapy in geriatric patients with stage IB-IIIB non-small cell lung cancer.Methods
Patients with stage IB-IIIB non-small cell lung cancer treated over 24 months (2022-2023) were identified in the National Cancer Database. Geriatric patients were defined as being older than 75 years. Geriatric patients and younger patients aged 75 years or less were compared in terms of treatment intensity, perioperative outcomes, and survival. Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analysis of survival. Multivariable logistic regression was used to analyze perioperative outcomes.Results
21,070 patients aged more than 75 years with clinical stage IB-IIIB non-small cell lung cancer were included in this analysis. Among them, 4467 (21.2%) received surgery and 447 (10.0%) received neoadjuvant immunotherapy, compared with 35.3% and 17.9% of younger patients, respectively (P < .001). Both surgery (adjusted HR 0.34 [0.27-0.43], P < .001) and neoadjuvant immunotherapy (0.39 [0.25-0.63], P < .001) were associated with improved survival in geriatric patients. Geriatric patients who received neoadjuvant immunotherapy also demonstrated acceptable perioperative outcomes.Conclusions
In a large national cohort, we show that although geriatric patients have lower treatment intensity than younger patients, both surgery and neoadjuvant immunotherapy render a survival benefit while retaining acceptable perioperative outcomes. Whenever possible, standard of care treatment should be pursued in geriatric patients, and age in isolation should not exclude patients from optimal treatments.
Related
- [Evolution of Perioperative Immunotherapy Paradigms in Non-small Cell Lung Cancer: From Adjuvant Dilemma to Neoadjuvant Priority].
- Efficacy and safety of neoadjuvant targeted therapy in surgically treated patients with ALK-rearranged non-small cell lung cancer
- Efficacy and safety of narlumosbart in combination with stereotactic body radiation therapy followed by first-line chemotherapy combined with immunotherapy in advanced driver gene-negative non-small cell lung cancer patients with bone metastases: a phase II, single-arm, single-centre clinical trial protocol
- Early Assessment of Circulating Tumor Cells and Their PD-L1 Expression as Predictive Biomarkers in Metastatic Non-Small Cell Lung Cancer Patients Treated with Immunotherapy: An Exploratory Study
- Integrative stratification of response to immunotherapy using host and microbial signatures in patients with advanced non-small cell lung cancer.
BibTeX
@article{dourlain2026neoadjuvant,
title = {{Neoadjuvant immunotherapy in geriatric patients with non-small cell lung cancer: A real-world analysis.}},
author = {Jordan Dourlain and Omar Bushara and Mohammad Saad Farooq and Julia Gasior and Karina Bruestle and Jarrod Predina and Doraid Jarrar and Giorgos Karakousis and John C Kucharczuk and Sunil Singhal},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101950},
url = {https://europepmc.org/article/MED/42948407},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Neoadjuvant immunotherapy in geriatric patients with non-small cell lung cancer: A real-world analysis.
AU - Jordan Dourlain
AU - Omar Bushara
AU - Mohammad Saad Farooq
AU - Julia Gasior
AU - Karina Bruestle
AU - Jarrod Predina
AU - Doraid Jarrar
AU - Giorgos Karakousis
AU - John C Kucharczuk
AU - Sunil Singhal
PY - 2026
DA - 2026/07/03
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101950
UR - https://europepmc.org/article/MED/42948407
AB - Objectives Neoadjuvant immunotherapy has been shown to significantly improve survival in patients with stage IB-IIIB non-small cell lung cancer. However, it is unknown whether geriatric patients experience similar benefits. Using a large national cohort, we studied outcomes of neoadjuvant immunotherapy in geriatric patients with stage IB-IIIB non-small cell lung cancer.Methods Patients with stage IB-IIIB non-small cell lung cancer treated over 24 months (2022-2023) were identified in the National Cancer Database. Geriatric patients were defined as being older than 75 years. Geriatric patients and younger patients aged 75 years or less were compared in terms of treatment intensity, perioperative outcomes, and survival. Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analysis of survival. Multivariable logistic regression was used to analyze perioperative outcomes.Results 21,070 patients aged more than 75 years with clinical stage IB-IIIB non-small cell lung cancer were included in this analysis. Among them, 4467 (21.2%) received surgery and 447 (10.0%) received neoadjuvant immunotherapy, compared with 35.3% and 17.9% of younger patients, respectively (P < .001). Both surgery (adjusted HR 0.34 [0.27-0.43], P < .001) and neoadjuvant immunotherapy (0.39 [0.25-0.63], P < .001) were associated with improved survival in geriatric patients. Geriatric patients who received neoadjuvant immunotherapy also demonstrated acceptable perioperative outcomes.Conclusions In a large national cohort, we show that although geriatric patients have lower treatment intensity than younger patients, both surgery and neoadjuvant immunotherapy render a survival benefit while retaining acceptable perioperative outcomes. Whenever possible, standard of care treatment should be pursued in geriatric patients, and age in isolation should not exclude patients from optimal treatments.
SN - 2666-2736
ER -