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Abstract：
The incidence of cancer is closely correlated with age, as 75% of non-small cell lung cancer (NSCLC) patients are aged at least 65 years. The availability of immune checkpoint inhibitors (ICIs) has altered the available NSCLC therapeutic pattern. Limited studies on elderly patients have demonstrated that ICIs as monotherapy provide substantial benefits for patients aged 65-75 years, showing no significant difference compared to younger patients. This benefit is also observed in combination with immune-combined chemotherapy or radiotherapy. For individuals older than 75 years, the survival effect was not evident, though. Immune-related adverse events (irAEs) with ICIs alone were similar in incidence across age categories. Immune-combination chemotherapy resulted in a higher incidence of irAEs than chemotherapy alone, and patients ≥75 years of age were more likely to experience higher-grade irAEs. Besides the fact that immunosenescence in older patients influences the immune milieu in a multifaceted manner, which in turn impacts the effectiveness of immunotherapy, the prognosis is also influenced by the Eastern Cooperative Oncology Group performance status (ECOG PS) score, among other factors. For certain individuals aged ≥75 years or in poor physical health, immunotherapy combined with low-intensity chemotherapy has emerged as a viable treatment option. However, there are fewer related studies, so there should be a conscious effort to increase the number of elderly patients enrolled in the trial and a comprehensive assessment to explore individualized treatment options. To provide additional references and guidance for immunotherapy in elderly NSCLC patients and to propose new therapeutic perspectives in combination with their characteristics, this review aims to summarize and analyze the pertinent studies on the application of programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors in these patients.
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【中文题目：老年晚期NSCLC患者PD-1/PD-L1 免疫检查点抑制剂治疗现状及展望】 【中文摘要：癌症发病率与年龄密切相关，75%的非小细胞肺癌（non-small cell lung cancer, NSCLC）患者年龄均≥65岁。免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）的出现改变了NSCLC的治疗格局。针对老年患者有限的研究发现对于65-75岁的患者，ICIs单药显示出良好的获益，与年轻患者无明显差异，这种获益在免疫联合化疗或放疗中也有所体现。但是对于≥75岁的患者来说生存获益不明显。ICIs单药在不同年龄段的患者中免疫相关不良反应（immune-related adverse events, irAEs）发生率相似，免疫联合化疗对比单纯化疗导致irAEs的发生率高，≥75岁患者发生更高级别irAEs的可能性更大。除了老年患者免疫衰老会从多维度影响免疫微环境从而影响免疫治疗疗效外，东部肿瘤协作组体力状态（Eastern Cooperative Oncology Group performance status, ECOG PS）评分等也会影响预后。对于部分≥75岁或身体状况较差的患者，免疫联合低强度化疗成为有潜力的治疗方式之一，但相关研究较少，所以应有意识增加老年患者入组试验的人数，同时综合评估，探索个体化治疗方案。本综述拟对老年NSCLC患者应用抗程序性死亡受体1（programmed cell death protein 1, PD-1）及其配体（programmed cell death ligand 1, PD-L1）的相关研究进行汇总分析，以期为老年NSCLC患者的免疫治疗提供更多参考和指导，并结合其特点提出新的治疗展望。 】 【中文关键词：肺肿瘤；老年非小细胞肺癌；免疫衰老；免疫治疗；免疫联合低强度化疗】.
【中文题目：老年晚期NSCLC患者PD-1/PD-L1 免疫检查点抑制剂治疗现状及展望】 【中文摘要：癌症发病率与年龄密切相关，75%的非小细胞肺癌（non-small cell lung cancer, NSCLC）患者年龄均≥65岁。免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）的出现改变了NSCLC的治疗格局。针对老年患者有限的研究发现对于65-75岁的患者，ICIs单药显示出良好的获益，与年轻患者无明显差异，这种获益在免疫联合化疗或放疗中也有所体现。但是对于≥75岁的患者来说生存获益不明显。ICIs单药在不同年龄段的患者中免疫相关不良反应（immune-related adverse events, irAEs）发生率相似，免疫联合化疗对比单纯化疗导致irAEs的发生率高，≥75岁患者发生更高级别irAEs的可能性更大。除了老年患者免疫衰老会从多维度影响免疫微环境从而影响免疫治疗疗效外，东部肿瘤协作组体力状态（Eastern Cooperative Oncology Group performance status, ECOG PS）评分等也会影响预后。对于部分≥75岁或身体状况较差的患者，免疫联合低强度化疗成为有潜力的治疗方式之一，但相关研究较少，所以应有意识增加老年患者入组试验的人数，同时综合评估，探索个体化治疗方案。本综述拟对老年NSCLC患者应用抗程序性死亡受体1（programmed cell death protein 1, PD-1）及其配体（programmed cell death ligand 1, PD-L1）的相关研究进行汇总分析，以期为老年NSCLC患者的免疫治疗提供更多参考和指导，并结合其特点提出新的治疗展望。 】 【中文关键词：肺肿瘤；老年非小细胞肺癌；免疫衰老；免疫治疗；免疫联合低强度化疗】.
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