AIMS First-line chemoimmunotherapy (ICI-chemo) has become the standard of care for extensive-stage small cell lung cancer (ES-SCLC). However, older adults are underrepresented in pivotal trials due to strict inclusion criteria that limit participation to highly selected, fit patients. Given the limited real-world comparative data, this study aimed to determine whether older adults with ES-SCLC derive greater benefit from ICI-chemo compared with chemotherapy (chemo) alone. PATIENTS AND METHODS We conducted a single-center retrospective cohort study including ES-SCLC patients aged 65 years or older who started first-line ICI-chemo or chemo between January 2020 and July 2024. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounding. The main outcome was overall survival (OS) in the IPTW population. RESULTS In the IPTW population, median OS was significantly longer in the ICI-chemo group (14.95 months; 95% CI, 12.94-19.91) compared with chemo (10.28 months; 95% CI, 8.11-13.17; HR, 0.66; 95% CI, 0.48-0.91; p = 0.011). Multivariable analysis confirmed that ICI-chemo exposure was independently associated with improved OS (HR, 0.608; 95% CI, 0.440-0.841; p = 0.003). CONCLUSIONS Our findings provide comparative evidence of improved survival in association with ICI-chemo compared with chemo in older adults with ES-SCLC.
AIMS To evaluate the cost-effectiveness of adding chemotherapy to first-line osimertinib compared with osimertinib alone among advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations in China. METHODS A partitioned survival model was developed to project lifetime costs and health outcomes. Model inputs included direct medical costs, utility, and clinical parameters. Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. The primary outcomes were total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS Osimertinib plus chemotherapy was associated with higher costs ($62,338.96 vs. $46,929.04) and greater QALYs (3.60 vs. 2.88) than monotherapy, yielding an ICER of $21,410.25 per QALY. Drug costs contributed most to the incremental costs in both arms. Deterministic sensitivity analysis identified the cost of pemetrexed as the most influential parameter. At its highest price, the ICER exceeded the willingness‑to‑pay threshold of $41,876.05 per QALY (three times China's 2025 per capita GDP); otherwise, results remained robust. Probabilistic sensitivity analysis indicated that the combination strategy had a 96.28% probability of being cost-effective. However, these findings should be interpreted with caution, given the extrapolated nature of the survival data. CONCLUSIONS Compared with osimertinib alone, osimertinib plus chemotherapy was likely to be cost-effective as first-line treatment for EGFR-mutated advanced NSCLC in China, but this cost-effectiveness was highly sensitive to the price of pemetrexed.
