Bronchial Artery Chemoembolization (BACE) Combined with PD-1 Blockade Versus Chemotherapy Combined with PD-1 Blockade for Non-Small Cell Lung Cancer in Older Adults

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Background: Systemic immunochemotherapy is the standard of care in patients with advanced non-small cell lung cancer (NSCLC) without druggable driving mutations, yet many older patients cannot tolerate systemic chemotherapy. Bronchial arterial chemoembolization (BACE) represents an alternative to systemic chemotherapy for this population. Methods: This retrospective single-center study included consecutive patients with stage IIIC-IV NSCLC over 65 years old who underwent BACE or systemic chemotherapy, plus a PD-1 inhibitor, in our hospital from August 2019 to October 2024. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were compared between the two groups. Results: The final analysis included 81 patients: 39 and 42 in the chemotherapy and BACE groups, respectively. In comparison to the chemotherapy group, the BACE group had older age (median age: 78 vs 71 years) and poorer Eastern Cooperative Oncology Group Performance Status (ECOG PS≥2: 47.6% vs 2.6%). The ORR was 73.8% in the BACE group vs 64.1% in the chemotherapy group. The median PFS was 5.4 months in the BACE group vs 5.2 months in the chemotherapy group (P=0.841). The median OS was 10.3 months in the BACE group vs 8.7 months in the chemotherapy group (P=0.449). Neither PFS nor OS differed significantly between the 2 groups in either Cox proportional hazards regression or inverse probability of treatment weighting analyses. The BACE group had lower rate of myelosuppression (28.6% vs 74.4%) but higher rate of dyspnea (16.7% vs 0%). No treatment-related serious AEs, eg, spinal artery injury due to ectopic embolism or venous thrombosis of the lower limb, were reported in the BACE group. Conclusion: In older patients with stage IIIC-IV NSCLC, BACE combined with PD-1 inhibitor showed no statistically inferior response or survival versus chemoimmunotherapy. These exploratory results require validation in large prospective cohorts.

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