ICI monotherapy benefits cancer patients aged 80 and older
medwireNews: Age alone should not preclude the use of immune checkpoint inhibitors (ICIs) in people with cancer aged 80 years or more, say researchers who found promising efficacy and tolerability of single-agent therapy in this patient population.
“There has been theoretical concern whether immunosenescence (age-related changes in immune function) could compromise ICI efficacy,” write Abdul Naqash (University of Oklahoma, Oklahoma City, USA) and co-authors in JAMA Oncology.
“Findings of this study suggest that this concern of immunosenescence and poor outcomes to ICIs may not translate to clinical practice.”
The chart review included data for 928 patients aged at least 80 years during single-agent ICI treatment at one of 18 medical centers in the USA or Europe in 2010–2019. The majority (86.9%) of participants received a PD-1 inhibitor, and the most common tumor types in the cohort were non-small-cell lung cancer (NSCLC; 37.2%), melanoma (35.5%), and genitourinary cancer (16.5%).
The objective response rate was 32.2% among the 276 response-evaluable NSCLC patients, 39.3% among the 280 melanoma patients, and 26.2% among the 126 with genitourinary tumors.
The median progression-free survival was 6.7, 11.1, and 6.0 months in the overall NSCLC, melanoma, and genitourinary cancer subgroups, respectively, and the corresponding median overall survival times were 10.9, 30.0, and 15.0 months.
Naqash and colleagues note that for each tumor type, “clinical outcomes were similar” between participants aged 85 years or older and those who were younger.
They also found that the rates of immune-related adverse events (irAEs) of any grade were similar between patients younger than 85 years, those aged 85–89 years, and those aged at least 90 years, at 43.1%, 37.2%, and 38.3%, respectively, and this was also the case for grade 3–4 irAEs, at 12.9%, 10.3%, and 11.7%.
However, patients aged 90 years or older were significantly more likely to discontinue ICI therapy due to irAEs than their younger counterparts, at rates of 30.9% versus 15.1%, report the researchers.
“This could suggest lower tolerance for toxic effects among this unique geriatric patient population, potentially driven by patient preference, declining functional status, or physician risk aversion,” they write.
The study authors therefore conclude that “[a]lthough a more precise understanding of age-related biology is warranted, findings of this study suggest that advanced age in itself should not preclude ICI therapy.
And they add: “Randomized clinical trials using ICIs for geriatric patients are needed to further elucidate the clinical effect of our findings and identify histology-specific outcomes using appropriate controls.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group