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

Jing Xiang,1,* Jianfei Tu,1,* Weiwei Gong,2 Panhang Chen,3 Yonghui Wang,1 Weiwen Li,1 Jieming Zhong,2 Jiansong Ji,4 Jianhui Huang1,31Department of Oncology Center, Lishui Central Hospital, Lishui, Zhejiang, 323000, People’s Republic of China; 2Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, People’s Republic of China; 3Department of Oncology Center, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, 323000, People’s Republic of China; 4Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, 323000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiansong Ji, Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, 323000, People’s Republic of China, Tel +86-0578-2285011, Email jjstcty@wmu.edu.cn Jianhui Huang, Department of Oncology Center, Lishui Central Hospital, Lishui, Zhejiang, 323000, People’s Republic of China, Tel +13967090390, Email huangjianhuiduo@163.comBackground: 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.Keywords: bronchial arterial chemoembolization, older adults, non-small lung cancer, immunotherapy, efficacy