Real-world clinical practice for advanced non-small-cell lung cancer in the very elderly: A retrospective multicenter analysis

•The PS 0 - 2 patients showed a longer median OS than the PS 3 -4 patients.•Biomarker-matched therapy is effective even in the very elderly.•Biomarker-matched therapy is related to better prognoses, even in the very elderly.•Chemotherapy for biomarker-negative/unknown PS 0 - 2 patients is questionable. The optimal treatment for advanced non-small cell lung cancer (NSCLC) in very elderly patients is unclear. We aimed to evaluate their treatment in real-world clinical practice and identify suitable therapy that can improve their prognosis. The medical records of 132 Japanese patients aged 80 years and older with advanced NSCLCs who were enrolled at a university hospital and its 9 affiliates were retrospectively analyzed. Clinical characteristics and overall survival (OS) were compared based on the Eastern Cooperative Oncology Group Performance Status (ECOG PS) and biomarker statuses. Patients were defined as biomarker-positive if programmed death-ligand 1 tumor proportion score (PD-L1 TPS) was ≥ 50% or activating mutations were present in epidermal growth factor receptor, anaplastic lymphoma kinase, or c-ros oncogene 1. Finally, the factors contributing to better prognosis were explored in both PS 0 - 2 and PS 3 - 4 patient groups. The PS 0 - 2 patients showed a longer median OS than the PS 3 - 4 patients (5.5 vs. 1.6 months). PS 0 - 2 patients with positive biomarkers who received chemotherapy showed a significantly longer median OS than those without (18.1 vs. 3.7 months). Among the biomarker-negative/unknown PS 0 - 2 patients, the median OS showed no significant difference between those who received chemotherapy and those who did not (4.5 vs. 3.1 months). The multivariate analysis showed that treatment with tyrosine kinase inhibitors or immune checkpoint inhibitors was related to better prognoses in the PS 0 - 2 group. Biomarker-matched therapy is effective even in very elderly patients. Meanwhile, the effectiveness of chemotherapy for biomarker-negative/unknown PS 0 - 2 patients is questionable. The present study aimed to investigate how advanced NSCLCs in the patients aged 80 and over were treated and what types of therapy can improve their prognosis. We found that biomarker-matched therapy (tyrosine kinase inhibitors or immune checkpoint inhibitors) was effective, while the effectiveness of chemotherapy, especially cytotoxic chemotherapy alone, for biomarker-negative/unknown patients was questionable.