Medical Education, Gundersen Health System, 1900 South Ave., La Crosse, WI 54650, USA.
Medical Education, Gundersen Health System, 1900 South Ave., La Crosse, WI 54650, USA.
J Geriatr Oncol. 2022 Sep;13(7):1011-1016. doi: 10.1016/j.jgo.2022.05.007. Epub 2022 May 28.
Increased immune checkpoint inhibitor (ICI) use in various advanced cancer types has led to a parallel rise in immune-related adverse events (irAEs). Despite widespread use, ICI data in older patients remains limited. We investigate irAE prevalence in older patients receiving ICI and whether irAEs and survival are associated.
Our retrospective study included patients aged ≥65 years with advanced malignancies who had ≥1 dose of ICI from January 2011 through September 2019. We evaluated irAE cases and their respective grades and assessed oncological response by progression-free survival (PFS) and overall survival (OS).
Mean age of 210 patients was 75.0 ± 7.2 years, 58.1% were men, and most were white. IrAE prevalence was 41.4% (n = 87); 9.5% (n = 20) developed multisystem irAE. Most irAEs were grades 1 and 2 (27.6% and 49.4%, respectively), while grades 3 and 4 accounted for 17.2% and 5.8%, respectively. No grade 5 irAE occurred. Compared with patients with no irAEs, those with irAEs had improved OS (HR [hazard ratio], 0.41; 95% CI [confidence interval], 0.282-0.597; p < 0.0001) and PFS (HR, 0.311; 95% CI: 0.213-0.453; p < 0.0001). Improved OS was seen with irAE grades 1 and 2 versus grades 3 and 4 (HR, 0.344; 95% CI: 0.171-0.694; p = 0.0029). Similarly, improved PFS was seen with lower grade irAE (HR, 0.489; 95% CI: 0.247-0.965; p = 0.0391).
The irAE prevalence in older patients was similar to that in younger patients. To our knowledge, this is one of few studies that confirms a positive association of irAE on both OS and PFS in older patients with cancer, and improved OS and PFS with lower versus higher grade irAE.
随着各种晚期癌症中免疫检查点抑制剂（ICI）的使用增加，免疫相关不良事件（irAE）也相应增多。尽管广泛应用，但老年患者的 ICI 数据仍然有限。本研究旨在探讨老年患者接受 ICI 治疗后 irAE 的发生率，以及 irAE 与生存的相关性。
我们的回顾性研究纳入了 2011 年 1 月至 2019 年 9 月期间≥65 岁、接受过至少一剂 ICI 治疗的晚期恶性肿瘤患者。我们评估了 irAE 病例及其相应的严重程度，并通过无进展生存期（PFS）和总生存期（OS）评估了肿瘤的缓解情况。
210 例患者的平均年龄为 75.0±7.2 岁，58.1%为男性，大多数为白人。irAE 的发生率为 41.4%（n=87）；9.5%（n=20）发生多系统 irAE。大多数 irAE 为 1 级和 2 级（分别为 27.6%和 49.4%），3 级和 4 级分别占 17.2%和 5.8%。未发生 5 级 irAE。与无 irAE 的患者相比，有 irAE 的患者 OS （HR[风险比]，0.41；95%CI[置信区间]，0.282-0.597；p<0.0001）和 PFS（HR，0.311；95%CI：0.213-0.453；p<0.0001）均得到改善。irAE 1 级和 2 级与 3 级和 4 级相比，OS 改善（HR，0.344；95%CI：0.171-0.694；p=0.0029）。同样，较低等级的 irAE 与 PFS 的改善相关（HR，0.489；95%CI：0.247-0.965；p=0.0391）。
老年患者 irAE 的发生率与年轻患者相似。据我们所知，这是为数不多的几项研究之一，证实了 irAE 对癌症老年患者的 OS 和 PFS 均有积极影响，并且较低等级的 irAE 与较高等级的 irAE 相比，OS 和 PFS 均得到改善。
