The Journal of Practical Medicine ›› 2026, Vol. 42 ›› Issue (17): 3035-3044.doi: 10.3969/j.issn.1006-5725.2026.17.001

• Guidelines·Consensus·Interpretation •     Next Articles

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

Lu Chen1, Danna Liu2, Bo Sun2, Hanli Zhou1, Xiaoli Zhao1, Tiandong Kong1()   

  1. 1. Department of Respiratory Oncology,Cancer Hospital of Henan University,the 3rd People′s Hospital of Zhengzhou,Zhengzhou 450000,Henan,Chin
    2. Department of Pharmacy,Cancer Hospital of Henan University,the 3rd People′s Hospital of Zhengzhou,Zhengzhou 450000,Henan,China
  • Received:2026-06-09 Online:2026-09-10 Published:2026-10-10
  • Contact: Tiandong Kong
  • About author:

    Kong Tiandong and Chen Lu designed the study and drafted the manuscript. Zhao Xiaoli, Sun Bo, and Zhou Hanli collected the data and reviewed the literature. Liu Danna reviewed the pharmaceutical literature and revised the adverse reactions section. All authors read and approved the final manuscript as submitted.

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

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