The Impact of Age on the Effectiveness of Immune Checkpoint Inhibitors Therapy in Patients with Metastatic Non-Small Cell Lung Cancer

The incidence of cancer increases with age. Immunosenescence, characterized by a decline in adaptive immunity and chronic low-grade inflammation, may influence the efficacy of immune checkpoint inhibitors (ICIs) in elderly patients. Background/Objectives: While some studies suggest comparable efficacy of ICIs across age groups, others report reduced response due to immune system dysregulation. This study aimed to assess the prognostic value of age in ICI therapy for metastatic non-small cell lung cancer (mNSCLC). Methods: A retrospective, single-center cohort study included 105 mNSCLC patients treated with pembrolizumab or atezolizumab at the Sumy Regional Clinical Oncology Center (Ukraine). Data on demographics, tumor histology, immunotherapy regimen, treatment response, survival outcomes, and immune-related adverse events (irAEs) were collected in medical records. Statistical analyses included chi-square tests, Kaplan-Meier survival analysis, and multivariate Cox regression. Results: The cohort comprised 89 males (84.8%) and 16 females (15.2%), with a mean age of 60.8 years. No significant differences were observed in treatment duration (p=0.9718), objective response rate (χ2=0.7112; p=0,701), or disease control rate (χ2=0.1103; p=0,946) among age groups. Median progression-free survival (PFS) was 6.3, 7.0, and 12.3 months for patients <60, 60–69, and ≥70 years, respectively (p=0.5254). Overall survival (OS) also showed no significant age-related differences (p=0.5441). However, older patients exhibited a higher incidence of irAEs (p=0.035). Multivariate analysis identified ICI treatment duration (p=0.0001) and objective response rate (p=0.009) as independent predictors of PFS. Conclusions: Age does not significantly impact ICI therapy efficacy in mNSCLC patients. However, elderly patients require careful monitoring due to an increased risk of irAEs.