Bronchial Arterial Chemoembolization with versus without Anlotinib in Elderly Patients with Advanced Non-Small Cell Lung Cancer: A Retrospective Case-Control Study

Purpose: To compare bronchial arterial chemoembolization (BACE) plus anlotinib versus BACE alone for advanced non-small cell lung cancer (NSCLC) in the elderly. Patients and Methods: We screened all elderly patients (≥ 75 years of age) receiving BACE (75 mg/m 2 cisplatin and 1000 mg/m 2 gemcitabine via feeding arteries and then embolization using microspheres) plus anlotinib (21-day cycles, 12 mg/day on the first 14 days of each cycle) or BACE alone for advanced NSCLC (stage III and IV) with no driver gene mutations at the participating centers from January 2018 to December 2023. Overall survival (OS) was analyzed in the overall and propensity score-matched (PSM) (1:1 ratio with 0.05 caliper width) cohorts, adjusting for confounders via PSM and stabilized inverse probability of treatment weighting (sIPTW). Results: The final analysis included 95 patients: 33 and 62 in the BACE/anlotinib and BACE groups, respectively. The median lines of previous anti-tumor therapy was 1 (range, 1– 3) and 1 (range, 1– 3) in the BACE/anlotinib and BACE groups, respectively. The median OS was 39 months and 18.9 months in the BACE/anlotinib and BACE groups, respectively (hazard ratio 0.12, 95% confidence interval 0.06– 0.24; P < 0.001). In multivariate Cox regression analysis, BACE plus anlotinib was associated with lower risk of death versus BACE alone (hazard ratio 0.15, 95% confidence interval 0.08– 0.29; P < 0.001). Longer OS in the BACE/anlotinib group was also evident in the PSM and sIPTW analyses. The rate of grade ≥ 3 adverse events was 24.2% in the BACE/anlotinib group versus 12.9% in the BACE group ( P = 0.16). Conclusion: In comparison to BACE, BACE plus anlotinib was associated with improved OS in elderly patients with NSCLC.