Table 1.

Expert Panel statements on the use of first-line immunotherapy in elderly patients with A-NSCLC

Panel questions	Expert conclusions
Elderly assessment
Q1. Is ‘elderly’ definition still adequate in the immunotherapy era?	Age is not per se a limitation for treatment selection but should be considered as a surrogate for other factors potentially related to age (ECOG PS, comorbidities).
Q2. In patients with A-NSCLC, does age affect your treatment choice with ICIs?	•No, for single-agent anti-PD-1/PD-L1. •Probably yes, for chemotherapy plus immunotherapy, mainly due to the concerns on toxicities from chemotherapy components.

Single-agent immunotherapy
Q3. Is single-agent immunotherapy feasible and safe in elderly patients with A-NSCLC and PD-L1 ≥50%?	Yes, with available data.
Q4. Is single-agent immunotherapy effective in elderly patients with A-NSCLC and PD-L1 ≥50%?	Yes, with available data.

Combined chemotherapy and immunotherapy
Q5. In elderly patients with A-NSCLC and squamous histology is combined chemotherapy plus single-agent immunotherapy feasible and safe?	Yes, but concerned about paclitaxel due to neurotoxicity.
Q6. Is combined chemotherapy plus single-agent immunotherapy effective in elderly patients with A-NSCLC and squamous histology?	Probably yes. We only have exploratory analysis from clinical trial KEYNOTE-407, showing no difference with 65 years cut-off.
Q7. In elderly patients with A-NSCLC and non-squamous histology is combined chemotherapy plus single-agent immunotherapy feasible and safe?	Yes, but concerns are expressed for combined chemotherapy plus immunotherapy in octogenarians. Caution on maintenance with pemetrexed.
Q8. Is combined chemotherapy plus single-agent immunotherapy effective in elderly patients with A-NSCLC and non-squamous histology?	Probably yes. We only have exploratory analysis from clinical trial KEYNOTE-189, showing no difference with 65 years cut-off.
Q9. In elderly patients with A-NSCLC is combined chemotherapy plus double immunotherapy feasible and safe?	Yes, considering that the regimen with two cycles of chemo without maintenance pemetrexed could be favorable in the elderly population.
Q10. In elderly patients with A-NSCLC is combined chemotherapy plus double immunotherapy effective?	Probably yes, as we cannot avoid treatment in the elderly based only on a small subgroup analysis on ≥75 years cut-off in the CM9LA.

Preferred treatments
Q11. In elderly patients with A-NSCLC and PD-L1 ≥50%, how do you choose between single-agent immunotherapy and combined chemo-immunotherapy?	Based on FDA pooled analysis and real-world data, it is reasonable to choose single-agent anti-PD-1/PD-L1, excluding never smokers (irrespective of age).

A-NSCLC, advanced non-small-cell lung cancer; ECOG, Eastern Cooperative Oncology Group; FDA, Food and Drug Administration; ICIs, immune checkpoint inhibitors; PD-1, programmed cell death protein 1; PD-L1, programmed cell death-ligand 1; PS, performance status; Q, question.