Key messages
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Medicines that help the body's immune system recognise and attack cancer cells can shrink the cancer and likely slow its return in people aged 65 years and older having surgery for the most common type of lung cancer. However, it probably does not increase how long people live overall.
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We do not have enough evidence yet to know if its benefits outweigh the harms, and no study assessed well-being.
What is resectable non-small cell lung cancer?
About 85% of people with lung cancer have what is called non-small cell lung cancer (NSCLC). It is most often found in older adults, with an average age at diagnosis of 71. When the cancer has not spread out of the lung, and if the person is fit enough to have surgery, the tumour can be removed. However, the cancer can come back after treatment, and between 30% and 55% of people eventually die from the disease. To reduce the risk of cancer coming back, different treatments can be used together.
How is resectable non-small cell lung cancer treated?
In recent years, lung cancer treatment has been transformed with the discovery of medicines that help the body's immune system recognise and attack cancer cells (immunotherapy). Immunotherapy works together with drugs that kill cancer cells (chemotherapy). When given before surgery, after surgery, or both, immunotherapy improves the chances of curing the cancer and helps delay its return.
What did we want to find out?
The ageing process affects the immune system, reducing its capacity to fight cancer: this is called immunosenescence. The elderly population is a very diverse group, and each person needs to be carefully assessed because age alone is not enough to base the best treatment decisions on. We wanted to find out if, despite immunosenescence, immunotherapy is effective in people aged 65 years and older, to cure lung cancer and prolong life without unwanted treatment effects.
What did we do?
We searched for high-quality studies that tested immunotherapy, either alone or in combination with chemotherapy, given before surgery, after surgery, or both, in people aged 65 and older. We summarised their results and assessed how confident we can be in the evidence, based on criteria such as how the studies were done and how many people were included.
What did we find?
For people aged 65 and older, we found results from 11 studies involving 3152 people with NSCLC. The studies compared immunotherapy alone or in combination with chemotherapy to a placebo (a sham or ‘dummy’ treatment) or no treatment, with or without chemotherapy. Treatments were given either only before surgery, only after surgery, or both before and after surgery.
Immunotherapy reduces the amount of cancer found at surgery and probably delays the cancer from coming back. Immunotherapy probably makes little or no difference to overall survival. There was not enough evidence to determine its effect on potential harms, and no study assessed well-being.
What are the limitations of the evidence?
Our confidence in most of the evidence is moderate because of some concerns about how the studies were conducted. More complete and longer-term data are needed to better estimate how much a person's lifespan might be extended. We have very limited confidence in the assessment of unwanted effects, because only one study provided data about these.
How up to date is this evidence?
The evidence is up to date to 3 July 2025.
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Задачи
To assess the benefits and harms of ICI with or without chemotherapy compared to no treatment or placebo with or without chemotherapy given before surgery, after, or both in older adults diagnosed with NSCLC at the early resectable stage.
Методы поиска
We searched for all eligible randomised controlled trials (RCTs) in electronic databases (CENTRAL, MEDLINE, and Embase), trial registries (clinicaltrials.gov and the World Health Organization ICTRP), references of eligible studies, meeting abstracts of the main world conferences, and the Food and Drug Administration (FDA) and European Medicines Agency (EMA) websites. The search was up to 3 July 2025.
Выводы авторов
In people aged ≥ 65 years old, the addition of ICIs probably results in little to no improvement in overall survival. Based on one study, treatment-related adverse events showed a similar profile, with low-certainty evidence. However, ICIs probably increase disease-free survival, event-free survival, and major pathological response rates by a clinically meaningful margin. ICI may also increase complete pathological response rates.
No study reported health-related quality of life assessments in older adults. Data were also insufficient to evaluate outcomes precisely in participants aged 65 to 75 years, those ≥ 75 years, or in PD-L1 stratified subgroups. We classified 12 studies as ongoing, as no results are yet available for elderly participants.
Финансирование
This Cochrane review had no dedicated funding.
Регистрация
Protocol available via DOI: 10.1002/14651858.CD014907.
