In a recent single center retrospective study in NSCLC patients, Lichtenstein et al

In a recent single center retrospective study in NSCLC patients, Lichtenstein et al. in clinical trials. Careful assessment and management of comorbidities is essential to achieve better outcomes and limit the immune related adverse Benzylpenicillin potassium events in elderly NSCLC patients. = 0.0008 to 2 mg/kg, HR: 0.61, 0.0001 to 10 mg/kg). Median PFS was similar across the groups (3.9 months with pembrolizumab 2 mg/kg, 4.0 months with pembrolizumab 10 mg/kg and docetaxel). Among patients with strongly positive PD-L1 (defined as the expression of PD-L1 in at least 50% of tumor cells), OS and PFS were significantly higher with pembrolizumab, regardless of the dose, than docetaxel (median OS: 14.9 and 17.3 months with pembrolizumab at 2 and 10 mg/kg, respectively, compared with 8.2 Benzylpenicillin potassium months with docetaxel; median PFS: 5.0 and 5.2 months with pembrolizumab at 2 and 10 mg/kg, respectively, compared to 4.1 months with docetaxel). In KEYNOTE 010, a subgroup analysis by defined age reported a significant reduction in the risk of death by 24% in 429 patients aged 65 years [HR: 0.76 (95% CI, 0.57C1.02). In KEYNOTE 024 60 Pembrolizumab as first line therapy showed an improvement in PFS of approximately 4 months compared to standard chemotherapy (10.3 vs. 6.0 months, HR 0.50) in NSCLC patients with PD-L1 expression more than 50%. This benefit was reconfirmed in all subgroups examined regardless of the patients age. 3.2. Nivolumab Nivolumab is a fully human IgG4 anti PD-1 antibody that controls the immune checkpoint and stops PD-1-mediated signaling and restores anti-tumor immunity. Nivolumab (3 mg/kg every 2 weeks) as single agent was compared with docetaxel as second-line treatment in squamous NSCLC (CheckMate-017) [58] and non-squamous NSCLC (Checkmate-057) [59], with OS as the primary endpoint in these two phase III studies. In Checkmate-017, the study population consisted of 272 patients with a mean age of 63 (range 39C85). The study revealed longer OS and PFS in nivolumab group than with docetaxel group regardless PD-L1 expression levels of the tumor (TPS 1%, 5% or 10%). An analysis of the subgroups shows improvement in OS and PFS in patients aged 65 to 75 years (HR of 0.56 and 0.51, respectively), but not in patients 75 years of age (OS HR: 1.85; PFS HR 1.76), although the small sample size (29 patients) does not allow statistically significant conclusions. In Checkmate-057, the study population consisted of a cohort of 582 patients with a median age of 62 (range 21C85). In this study the OS was significantly longer with nivolumab than with docetaxel, with a 27% lower death risk in the nivolumab group (HR: 0.73, 96% CI, 0.59C0.89, = 0.002), a benefit in terms of median survival of 2.8 months (median OS 12.2 vs. 9.4 months) and a 1-year OS rate of Benzylpenicillin potassium 51% compared to 39% with docetaxel. Although non-squamous PFS did not favor nivolumab compared to docetaxel (median 2.3 vs. 4.2 months, respectively), the PFS rate at 1 year was higher with nivolumab compared to chemotherapy (19% and 8%, respectively). In contrast to CheckMate-017, the magnitude of benefit across all efficacy endpoints seemed to be related to PD-L1 expression. An analysis of the subgroups shows an improvement in OS and PFS in patients aged 65 to 75 years (HR of 0.63 and 0.94, respectively), and in patients 75 years of age (OS HR: 0.90, PFS HR 0.97. Recently, the efficacy and safety of nivolumab were further reassessed in 70 patients 75 years (68 patients evaluable per response) with advanced non-squamous NSCLC. This subpopulation benefits from treatment with nivolumab, which reports a disease control rate of 42.9%, a median PFS and an OS of 3.2 and 7.6 months respectively. 3.3. Atezolizumab Atezolizumab is an engineered anti PD-L1 SEL-10 monoclonal antibody that inhibits PD-L1/PD1 and PD-L1/B7.1 interaction. The activity of this antibody restores and improves the antitumor activity of T cells. Efficacy data of Atezolizumab have been Benzylpenicillin potassium evidenced by the phase III OAK study [60]. In this study, 1225 patients were recruited and divided Benzylpenicillin potassium into two groups. In the first group, Atezolizumab 1200 mg IV was given every 3 weeks, and Docetaxel 75 mg/m2 was given every 3 weeks in the second group. In Atezolizumab group, an improvement in OS compared with docetaxel was observed in ITT population: median overall survival was 138 months vs. 96 months; HR = 0.73, = 0.0003). The improvement in observed OS was consistently demonstrated in the various patient subgroups, including those with brain metastases at baseline (HR of 0.54, 95% IC: 0.31C0.94, median OS of 20, 1 versus 11.9 months respectively with atezolizumab and docetaxel), without any history of smoking (HR = 0.71, 95% IC: 0.47C1.08, median OS of 16.3 versus 12, 6 months respectively with atezolizumab and docetaxel); furthermore overall survival improvement was similar in patients with.