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The phase 3 study enrolled 453 individuals with stage IIIB or IV disease lacking EGFR or ALK alterations who were considered unsuitable for platinum-doublet chemotherapy by the investigator because they had an ECOG performance status of 2 or 3 or were aged at least 70 years with substantial comorbidities or contraindications.

There was also a significant decrease in the incidence of secondary malignant neoplasms and neurologic and gastrointestinal comorbidities over time.

The options for treatment vary depending on whether patients do or do not have contraindications for immunotherapy ( details available in the ESMO Clinical Practice Guideline for managing toxicities of immunotherapy ), and also take into account factors such as histology, PD-L1 expression levels, performance status and comorbidities.

The prospective study included 295 women (median age 69 years) with stage I–III breast cancer who were considered clinically robust according to the Deficit Accumulation Index (DAI), which evaluates health status according to deficits in physical and instrumental activities of daily living, psychosocial status, nutrition, frequency of falls, number of medications, comorbidities, social support, and laboratory data.

After adjusting for multiple confounders, such as age, sex, comorbidities, and histology, receipt of immunotherapy was associated with a significantly reduced risk for death, at a hazard ratio (HR) of 0.74.

Applying stepwise Cox regression, the team identified several baseline variables significantly associated with an increased risk for drug-related ILD/pneumonitis, namely: age less than 65 years; enrollment in Japan; T-DXd dose greater than 6.4 mg/kg; oxygen saturation less than 95%; moderate or severe renal impairment; presence of lung comorbidities (not including lung cancer); and  time since initial cancer diagnosis of more than 4 years.

Patients with a daily steroid dose greater than 10 mg prednisone daily equivalent and those with pulmonary comorbidities were also at greater risk for death in the month after infection than other individuals, as were men compared with women.

They say: “In the debate about the best first-line approach for patients with high PD-L1 expression, between single-agent ICIs and chemoimmunotherapy combinations, a conservative approach could be considered for some patients with a low NLR, who derive a greater benefit from immunotherapy than chemotherapy when we consider patients’ comorbidities and disease burden.”

Radiotherapy is limited to growing or recurrent tumors in patients with comorbidities and for those in whom surgery would result in a significant functional deficit.

Multivariable analysis adjusting for age, family history of prostate cancer, comorbidities, and other confounders showed a time-dependent association between use of 5-ARIs and a reduced risk for PCM.

The researchers say that “[o]ngoing studies such as the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterization Protocol UK will enable a more comprehensive comparison of patients with cancer vs control patients, with adjustments for age, sex, and other comorbidities, and the identification of the true risk of different tumor types and treatments while controlling for patient-level factors.”

The findings conflict with some previous reports but the researchers say that “[t]he amalgamation of these and other conflicting data may contribute to clinical decision-making for men with prostate cancer eligible for treatment with these therapies, especially those with significant neurologic comorbidities.”

But the authors stress that “[n]one of the assays are recommended for treatment guidance in individuals with HER2-positive or triple-negative breast cancer,” and that “[t]reatment decisions should also consider disease stage, comorbidities, and patient preferences.”

They say that “these findings provide evidence to support considering the use of adjuvant RT in men with pN1 [prostate cancer] and using a personalized approach on the basis of the number of positive pelvic LNs and other comorbidities.”

Overall, 82.3% of patients had one or more comorbidities, such as hypertension (48.0%), chronic obstructive pulmonary disease (24.5%), or diabetes (19.3%).

Two papers from the prospective, longitudinal UK CAPTURE consortium shed light on the humoral and cellular immune response to SARS-CoV-2 vaccination and infection in patients with cancer.

They found that patients diagnosed in the first outbreak were significantly more likely to be aged 65 years or older (60.3% of 1626 vs 56.1% of 1008), have advanced tumors (46.4 vs 56.1%), and have at least two comorbidities (48.8 vs 42.4%) than those diagnosed in the first second outbreak.

The team concludes: “Beyond just treatment for existing comorbidities, our results provide support for the chemotherapeutic role of metformin and statins in preventing progression to lethal [prostate cancer] in men diagnosed [with] advanced [prostate cancer].” medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group Prostate Cancer Prostatic Dis 2021; doi:10.1038/s41391-021-00475-5

The risk remained similarly high after taking into account cancer treatment but fell to 65% when comorbidities were also accounted for.