REVIEW article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1589846
This article is part of the Research TopicTailored Strategies for Lung Cancer Diagnosis and Treatment in Special PopulationsView all 10 articles
Perioperative immune checkpoint inhibitors in elderly patients with resectable NSCLC: a systematic review and meta-analysis
Provisionally accepted
- 1Department of Pharmacy, Beijing Health Vocational College, Beijing, China
- 2Department of Medical Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Perioperative immunotherapy has shown promising results in patients with resectable stage II-III non-small cell lung cancer (NSCLC). However, its benefits for the specific subgroup of elderly patients remain unclear. This study aims to evaluate the efficacy of perioperative immunotherapy in elderly NSCLC patients aged 65 and above, focusing on key metrics such as pathological complete response (pCR), event-free survival (EFS), and overall survival (OS).We conducted a comprehensive meta-analysis of randomized clinical trials that reported subgroup data on elderly patients regarding pCR rates and hazard ratios (HRs) for EFS and OS. Data were retrieved from PubMed, EMBASE, and proceedings of oncology conferences from January 2020 to June 2025. A fixed effects model was used for the meta-analysis. Aggregated pooled HRs for time-to-event outcomes (EFS and OS), odds ratios (OR) and risk ratios (RRs) for dichotomous outcomes (pCR) were calculated specifically for patients aged ≥65 years who received perioperative immunotherapy or placebo.A total of 8 randomized controlled trials involving 1561 patients aged ≥65 years with resectable NSCLC were included. A significant benefit was observed in terms of pCR (risk ratio, 5.26; 95% CI, 3.54 -7.82; I² = 0%) and EFS (HR, 0.64; 95% CI, 0.55 -0.74; I² = 7%) for patients aged ≥65 years who received perioperative immunotherapy compared with placebo. However, no significant difference in overall survival (HR, 0.99; 95% CI, 0.72 -1.36; I² = 0%) was observed between the two groups.Our systematic review and meta-analysis demonstrated that perioperative immunotherapy was superior to placebo in terms of pathological and event-free survival for patients aged ≥65 years. These findings provide age-specific evidence to inform precision decision-making for treating the elderly patients.
Keywords: perioperative immunotherapy, Resectable NSCLC, elderly patients, Meta - analysis, Pathologic complete response, Event-free survival (EFS)
Received: 08 Mar 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Cao, Tian and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lin Li, Department of Medical Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.