Kanesvaran Ravindran, Cordoba Raul, Maggiore Ronald
From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY.
Am Soc Clin Oncol Educ Book. 2018 May 23;38:400-414. doi: 10.1200/EDBK_201435.
Immunotherapy has expanded the therapeutic landscape for advanced cancers, including solid tumors and lymphomas. For many patients with cancer, these agents have been shown to have substantial efficacy and favorable toxicity compared with cytotoxic agents, particularly in the second-line setting. With the advent of anti-PD-1 and anti-PD-L1 checkpoint inhibitors, combination immunotherapy- and chemoimmunotherapy-based strategies have emerged as promising novel regimens to improve cancer-related outcomes. Older adults age 65 or older represent the growing majority of patients diagnosed with cancer. However, older adults are under-represented in clinical trials in general, as well as in the landmark studies that led to approval of these immunotherapy agents. Because of increasing age and attendant multimorbidity and impaired functional status, many of these patients seen in the community-based oncology practices would not have been considered eligible for such studies. Thus, the results of these studies are difficult to generalize to a broader patient population with these competing risks. Furthermore, robust evaluation of toxicities, effect on quality of life and functional status, and aging-related (i.e., immunosenescence) and immunotherapy-related changes affecting the immune system remain underexplored research areas for older adults. This review examines the role of immunotherapy and its unique issues, specifically in older adults with lung cancer, bladder cancer, and lymphomas.
免疫疗法拓展了晚期癌症的治疗领域，包括实体瘤和淋巴瘤。对于许多癌症患者而言，与细胞毒性药物相比，这些药物已显示出显著疗效且毒性较低，尤其是在二线治疗中。随着抗PD-1和抗PD-L1检查点抑制剂的出现，基于联合免疫疗法和化疗免疫疗法的策略已成为有望改善癌症相关预后的新型方案。65岁及以上的老年人在确诊癌症的患者中占比越来越大。然而，老年人在一般临床试验以及导致这些免疫疗法药物获批的标志性研究中所占比例较低。由于年龄增长以及随之而来的多种合并症和功能状态受损，在社区肿瘤学实践中见到的许多此类患者不会被认为有资格参加此类研究。因此，这些研究结果难以推广到具有这些竞争风险的更广泛患者群体。此外，对于毒性、对生活质量和功能状态的影响以及影响免疫系统的衰老相关（即免疫衰老）和免疫疗法相关变化的有力评估，仍是老年人群体中尚未充分探索的研究领域。本综述探讨了免疫疗法的作用及其独特问题，特别是在老年肺癌、膀胱癌和淋巴瘤患者中的情况。
