Frailty, initial attrition and the potential use of novel platinum-free options for non-small-cell lung cancer in the real-world setting

Background: How frailty limits initial therapy in non-small-cell lung cancer (NSCLC) remains poorly understood and was the focus of this study. Methods: 2592 consecutive patients with metastatic NSCLC between 2018-2023 in Heidelberg were retrospectively analyzed. Results: Systemic therapy was initiated in 74% of patients with PD-L1 0-49% (n=1306) vs. 79% with PD-L1 [≥]50% (n=507, p=0.014), in whom the availability of monoimmunotherapy reduced best supportive care by own choice (1.8% vs. 4.5%, p=0.005), or for medical reasons (mBSC 14.6% vs. 17.8%, p=0.11), while early death remained unchanged (ca. 4%). 70% of patients receiving mBSC were initially treatable but suffered deterioration assoc