《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

doi:10.3969/j.issn.1006-5725.2026.17.001

Abstract

Abstract:

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 underrepresentation 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 comprehensive 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 multidimensional 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 considered 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 delineates 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.

Key words: non-small cell lung cancer, immune checkpoint inhibitors, elderly patients, comprehensive geriatric assessment, treatment strategy

CLC Number:

R734.2

Lu Chen, Danna Liu, Bo Sun, Hanli Zhou, Xiaoli Zhao, Tiandong Kong. Interpretation of the Chinese Expert Consensus on Immune Checkpoint Inhibitor Therapy for Elderly Patients with Advanced Non-Small Cell Lung Cancer （Version 2025）： From evidence to clinical practice[J]. The Journal of Practical Medicine, 2026, 42(17): 3035-3044.

Figures/Tables 2

Tab.1

Tab.2

References 46

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	条目	得分
1	在过去3个月中，是否由于食欲不振、消化问题或咀嚼吞咽困难，您的进食量有所下降？	0：进食量严重减少； 1：进食量中度减少； 2：进食量没有减少
2	过去3个月中，有体质量下降吗？	0：体质量下降> 3 kg 1：不知道 2：体质量下降1 ~ 3 kg 3：没有体质量下降
3	行走能力	0：只能躺卧或者坐着 1：能离开床或椅子行走，但不能出门 2：可以出门
4	神经精神问题	0：严重痴呆或抑郁 1：轻度抑郁 2：没有精神心理问题
5	BMI	0：BMI < 19 kg/m² 1：BMI 19 ~ < 21 kg/m² 2：BMI 21 ~ < 23 kg/m² 3：BMI ≥ 23 kg/m²
6	每天服用3种以上处方药	0：是 1：否
7	与同龄人相比，患者对自身健康状况评价	0：更差 0.5：不知道 1：一样好 2：更好
8	年龄	0：> 85岁 1：80 ~ 85岁 2：< 80岁
	总分	0 ~ 17分

评估维度	推荐工具	功能受损定义	对抗肿瘤治疗建议
躯体功能	IADL/ADL量表	任何功能失能或需辅助	①考虑单药治疗；②初始剂量降低20%（耐受后递增）； ③延长给药间隔；④增加毒性监测频率
	跌倒史	半年内≥ 1次跌倒	监测血压、调整相关药物、评估治疗风险
	4 m步行速度	走4 m耗时≥ 4 s	针对性干预（锻炼、助步器）
营养状态	体质量变化	3个月内下降>3 kg	①营养干预；②慎用高止吐药物、强化止吐
精神状态	简化PROMIS量表	≥ 11分	心理干预
精神状态	简化GDS量表	≥ 2分	心理干预
认知功能	迷你认知评估量表	0 ~ 2分	书面指导、简化医嘱
社会支持	简化MOS社会支持量表	任何项目缺乏支持	强化社会支持网络
合并症/多重用药	特定合并症评估	≥ 3项合并症或需特殊干预疾病	①依据共病调整方案；②审视药物相互作用，简化用药； ③针对性辅助，优化沟通方式
合并症/多重用药	听力、视觉评估	存在听力/视觉障碍	①依据共病调整方案；②审视药物相互作用，简化用药； ③针对性辅助，优化沟通方式
化疗风险评估	CARG化疗风险评估量表	6 ~ 9分（中危） 10 ~ 23分（高危）	中高危：考虑单药、减量、延长间隔、加强监测

Interpretation of the Chinese Expert Consensus on Immune Checkpoint Inhibitor Therapy for Elderly Patients with Advanced Non-Small Cell Lung Cancer （Version 2025）： From evidence to clinical practice

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