Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Kingston General Health Research Institute, and Department of Public Health Sciences, Kingston, Ontario, Canada.
J Geriatr Oncol. 2019 May;10(3):411-414. doi: 10.1016/j.jgo.2018.07.015. Epub 2018 Aug 10.
Immunotherapy has emerged as an effective treatment option for the management of advanced cancers. The effects of these immune checkpoint inhibitors in the older patient population has not been adequately assessed.
To understand the impact of aging on CTLA-4 and PDL-1 inhibitors efficacy and immune-related adverse events (irAE) in the context of real-world management of advanced solid cancers.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study involved all non-study patients with histologically-confirmed metastatic or inoperable solid cancers receiving immunotherapy at Kingston Health Sciences Centre. We defined 'older patient' as age ≥ 75. All statistical analyses were conducted under SPSS IBM for Windows version 24.0.
Study outcomes included immunotherapy treatment response, survival, as well as number, type, and severity of irAEs.
Our study (N = 78) had 29 (37%) patients age <65, 26 (33%) patients age 65-74, and 23 (30%) patients age ≥75. Melanoma, non-small cell lung cancer, and renal cell carcinoma accounted for 70%, 22%, and 8% of the study population, respectively. Distributions of ipilimumab (32%), nivolumab (33%), and pembrolizumab (35%) were similar in the study. The response rates were 28%, 27%, and 39% in the age <65, age 64-74, age ≥75 groups, respectively (P = 0.585). Kaplan-Meier curve showed a median survival of 28 months (12.28-43.9, 95% CI) and 17 months (0-36.9, 95% CI) in the age <65 and age 64-74 groups, respectively; the estimated survival probability did not reach 50% in the age ≥75 group (P = 0.319). There were no statistically significant differences found in terms of irAEs, multiple irAEs, severity of grade 3 or higher, types of irAEs, and irAEs resolution status when comparing between different age groups.
Our results suggest that patients age ≥75 are able to gain as much benefit from immunotherapy as younger patients, without excess toxicity. Our findings suggest that single agent immunotherapy is generally well-tolerated across different age groups with no significant difference in the type, frequency or severity of irAEs. Future studies evaluating aging and combination immunotherapy are warranted.
免疫疗法已成为治疗晚期癌症的有效治疗选择。这些免疫检查点抑制剂在老年患者人群中的效果尚未得到充分评估。
了解在晚期实体瘤的实际管理中，衰老对 CTLA-4 和 PDL-1 抑制剂疗效和免疫相关不良事件（irAE）的影响。
设计、地点和参与者：本回顾性研究涉及在金士顿健康科学中心接受免疫治疗的所有组织学证实的转移性或不可手术的实体癌的非研究患者。我们将“老年患者”定义为年龄≥75 岁。所有统计分析均在 IBM SPSS for Windows 版本 24.0 下进行。
研究结果包括免疫治疗反应、生存以及 irAE 的数量、类型和严重程度。
我们的研究（N=78）中有 29 名（37%）患者年龄<65 岁，26 名（33%）患者年龄 65-74 岁，23 名（30%）患者年龄≥75 岁。黑色素瘤、非小细胞肺癌和肾细胞癌分别占研究人群的 70%、22%和 8%。研究中伊匹单抗（32%）、纳武利尤单抗（33%）和派姆单抗（35%）的分布相似。年龄<65、64-74 和≥75 组的反应率分别为 28%、27%和 39%（P=0.585）。Kaplan-Meier 曲线显示年龄<65 和 64-74 组的中位生存时间分别为 28 个月（12.28-43.9，95%CI）和 17 个月（0-36.9，95%CI）；≥75 组的估计生存概率未达到 50%（P=0.319）。在不同年龄组之间，irAE、多种 irAE、3 级或以上严重程度、irAE 类型和 irAE 缓解状态方面，未发现统计学上的显著差异。
我们的结果表明，≥75 岁的患者与年轻患者一样能从免疫治疗中获益，且毒性无增加。我们的发现表明，单药免疫治疗在不同年龄组中普遍耐受良好，irAE 的类型、频率或严重程度无显著差异。需要进一步研究评估衰老和联合免疫治疗。
