Frailty, initial attrition and feasibility of novel platinum-free options for advanced non-small-cell lung cancer in the real-world setting

Abstract Background How frailty limits initial therapy in metastatic non-small-cell lung cancer (mNSCLC) remains poorly understood and was investigated in this study. Methods We retrospectively analyzed 2592 consecutive patients with mNSCLC treated between 2018-2023. Results Systemic therapy was initiated in 74% of patients with PD-L1 0-49% (n=1306) vs. 79% with PD-L1 ≥50% (n=507, p=0.014), in whom availability of monoimmunotherapy reduced best supportive care (16.4% vs. 22.3%, p=0.0002), while early death remained unchanged (ca. 4%). 70% of patients receiving mBSC were initially treatable but suffered early deterioration associated with comorbidities, metastatic burden, or protracted workup (p80 years, or ECOG performance status (PS) ≥3, or comorbidities with PS ≥2 or age ≥70, were fulfilled by 38% (n=501) and associated with 3-fold higher risk of death without therapy (230/501) compared to non-SmPC patients (p