Combined chemo-immunotherapy in advanced non-small cell lung cancer: feasible in the elderly?

IntroductionLung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) as the most common subtype. In the past decades, immunotherapy deeply changed paradigms for care of newly diagnosed advanced NSCLC patients without oncogenic driver mutations. An immunotherapy-based regimen alone or in combination to chemotherapy was crowned as the preferred option to choice, according to worldwide guideline.Areas coveredNewly diagnoses of advanced NCSLC occurred predominantly in elderly patients, representing over half of patients treated in daily practice. However, data on older patients' treatments are still lacking, because they are under-represented in clinical trials. This leads to a 'black hole' of knowledge about efficacy and safety of immune-checkpoint inhibitors use in this cohort of population.Expert opinionAccording to available data from subgroup analyses, immunotherapy as single agent seem to work in elderly similarly to younger patients, with no excess of toxicities. In contrast, the real impact - and not least the safety - of an immune-chemo combination use in elderly population was still unclear. Awaiting data from dedicated clinical trials, this review will discuss available results from randomized phase III clinical trials comparing immune-chemo combinations to chemotherapy alone, focusing on elderly subgroup enrolled.