《老年晚期非小细胞肺癌免疫检查点抑制剂治疗中国专家共识(2025版)》解读:从证据到临床实践的思考OA

Immune checkpoint inhibitors(ICIs)have become a cornerstone in the treatment of driver-gene-negative and EGFR-TKI-resistant advanced non-small cell lung cancer(NSCLC).With the accelerating aging of the global population,the proportion of elderly patients diagnosed with advanced NSCLC continues to increase,posing unique clinical challenges for ICI therapy.These challenges stem from age-related reductions in organ reserve,higher comorbidity burdens,and a higher prevalence of frailty in this population.However,most pivotal phase Ⅲ clinical trials only enrolled patients with a median age of 61 ‑ 65 years old,leading to substantial under‑representation of elderly individuals,particularly those aged≥75 years old.The Chinese Expert Consensus on Immune Checkpoint Inhibitor Therapy for Elderly Patients with Advanced Non-Small Cell Lung Cancer(2025 Edition)is the first standardized clinical guidance specifically developed for ICI treatment in elderly Chinese patients with NSCLC.This article systematically interprets the core content of this consensus,highlighting that comprehen‑sive geriatric assessment(CGA)serves as the cornerstone for guiding immunotherapy decision-making for elderly patients with lung cancer,and recommends combining the G8 screening tool with ASCO-recommended multidimen‑sional assessment instruments.The consensus proposes an age-stratified treatment algorithm for the first time:for patients aged 65 ‑ 74 years old,immunotherapy combined with platinum-based doublet chemotherapy is the preferred first-line regimen;for patients aged≥75 years old,treatment decisions should be individualized based on PD-L1 expression levels and tolerance status.Specifically,ICI monotherapy is recommended for patients with high PD-L1 expression(≥50%),while ICIs combined with or without single-agent chemotherapy can be consid‑ered for patients with low PD-L1 expression.The consensus also provides in-depth discussion on the pattern of immune-related adverse events(irAEs)and corresponding management strategies in elderly patients,and delin‑eates future research directions including the development of localized geriatric assessment tools and prospective clinical trials specifically targeting older adults.The publication of this consensus fills an important gap in the standardization of ICI therapy for elderly patients with lung cancer in China,and has important guiding value for improving the homogeneity of clinical practice.Nevertheless,its recommendations still require further validation and refinement in real-world studies and prospective clinical trials.