Department of Urology, Ludwig Maximilians University, Munich, Germany.
Department of Urology, Ludwig Maximilians University, Munich, Germany.
J Geriatr Oncol. 2020 Sep;11(7):1061-1066. doi: 10.1016/j.jgo.2020.06.012. Epub 2020 Jun 18.
Immunosenescence might impact immunotherapy (IT) in patients with advanced age. However, pivotal studies were not powered for this clinical question. Our aim is to explore toxicity (primary objective) and activity (secondary objective) of immune checkpoint inhibitors (ICIs) in patients with renal cell (RCC) and urothelial carcinoma (UC) older than 75 years compared to the younger population.
Patients treated at our tertiary care Uro-oncology Department with atezolizumab, pembrolizumab, nivolumab or ipilimumab were retrospectively analyzed. Immune-related adverse events (irAEs) were determined and graded using the Common Terminology Criteria for Adverse Events (CTCAE v.4.0). Disease Control rate (DCR) was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST v1.1). IrAEs and DCR were compared between patients ≥75 vs. <75 years, chi-squared test. Impact of age and other key clinical parameters on irAEs and DCR were tested in a binary logistic regression employing a backward selection. Impact of irAEs on oncological prognosis was assessed in log-rank and Cox regression analyses.
We included 99 patients treated between 11/2015 and 01/2019. Frequency of irAEs (36.4% vs. 39.4%) and DCR (59.4% vs. 41.0%) was comparable between patients ≥75 vs. <75 years. Advanced age was not associated with irAEs or worse DCR. IrAEs occurrence correlated with better disease-specific survival in the univariate and multivariate analyses. IrAEs could be successfully treated with corticosteroids in 78.9% of cases.
ICIs seem to be both safe and efficacious in an aging population with metastatic RCC or UC. Occurrence of irAEs predicted better prognosis.
免疫衰老可能会影响老年患者的免疫治疗（IT）。然而，关键研究没有针对这个临床问题进行研究。我们的目的是探索在年龄大于 75 岁的肾细胞癌（RCC）和尿路上皮癌（UC）患者中，与年轻患者相比，免疫检查点抑制剂（ICI）的毒性（主要目标）和活性（次要目标）。
回顾性分析了在我们的三级保健泌尿科肿瘤学系接受阿替利珠单抗、帕博利珠单抗、纳武利尤单抗或伊匹单抗治疗的患者。使用不良事件通用术语标准（CTCAE v.4.0）确定并分级免疫相关不良事件（irAEs）。根据实体瘤反应评估标准（RECIST v1.1）评估疾病控制率（DCR）。采用卡方检验比较≥75 岁与<75 岁患者之间的 irAEs 和 DCR。采用向后选择的二元逻辑回归模型检验年龄和其他关键临床参数对 irAEs 和 DCR 的影响。采用对数秩和 Cox 回归分析评估 irAEs 对肿瘤预后的影响。
我们纳入了 2015 年 11 月至 2019 年 1 月期间接受治疗的 99 例患者。≥75 岁与<75 岁患者的 irAEs 发生率（36.4% vs. 39.4%）和 DCR（59.4% vs. 41.0%）相似。高龄与 irAEs 或较差的 DCR 无关。在单因素和多因素分析中，irAEs 的发生与更好的疾病特异性生存相关。irAEs 可在 78.9%的病例中用皮质类固醇成功治疗。
ICI 似乎在老年转移性 RCC 或 UC 患者中既安全又有效。irAEs 的发生预测预后更好。
