Cancer Medicine Department, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy.
Cancer Medicine Department, Gustave Roussy, Villejuif, France.
Cancer Treat Rev. 2022 May;106:102394. doi: 10.1016/j.ctrv.2022.102394. Epub 2022 Apr 13.
Immune checkpoint blockers (ICBs) have a pivotal role in the management of non-small cell lung cancer (NSCLC), both as single agent and in combination strategies, providing a meaningful clinical and survival benefit. Older patients are underrepresented in clinical trials, including those involving immunotherapy, even though almost half of the patients with newly diagnosed NSCLC are aged 70 years or older. Moreover, due to selection biases, usually "fit" patients are preferably enrolled. This results in a lack of evidence regarding the use of ICBs in the older population, particularly when referring to chemo-immunotherapy regimens. Since ICBs are indeed of paramount importance in the treatment of patients with NSCLC, efforts are needed to optimize their use also in the older population. This entails furthermore taking into account additional features including the degree of fitness of the patient and the different health domains that can be affected by aging. This review aims to delve into the current evidences about the efficacy and toxicity of ICBs in monotherapy and in combination in older patients with advanced NSCLC, the role of the comprehensive geriatric assessment in supporting the selection of patients receiving immunotherapy, as well as the value of immunosenescence in modulating the activity of these drugs.
免疫检查点抑制剂 (ICBs) 在非小细胞肺癌 (NSCLC) 的治疗中具有重要作用，无论是作为单一药物还是联合治疗策略，都能提供有意义的临床和生存获益。在临床试验中，包括免疫治疗在内，老年患者代表性不足，尽管近一半的新诊断 NSCLC 患者年龄在 70 岁或以上。此外，由于选择偏倚，通常优先招募“合适”的患者。这导致在老年人群中使用 ICBs 的证据不足，特别是在涉及化疗免疫治疗方案时。由于 ICBs 在 NSCLC 患者的治疗中确实至关重要，因此需要努力优化其在老年人群中的使用。这还需要考虑到其他一些特征，包括患者的健康状况和可能因衰老而受到影响的不同健康领域。本文旨在深入探讨 ICBs 在晚期 NSCLC 老年患者中作为单药治疗和联合治疗的疗效和毒性的现有证据、综合老年评估在支持免疫治疗患者选择中的作用，以及免疫衰老在调节这些药物活性方面的价值。
