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癌症老年患者免疫检查点抑制剂免疫治疗毒性的危险因素。

Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer.

机构信息

Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

College of Medicine, The Ohio State University, Columbus, OH, USA.

出版信息

Oncologist. 2023 Aug 3;28(8):e625-e632. doi: 10.1093/oncolo/oyad097.


DOI:10.1093/oncolo/oyad097
PMID:37085156
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10400153/
Abstract

OBJECTIVES: Immune checkpoint inhibitor immunotherapy (IO) is revolutionizing cancer care but can lead to significant toxicity. This study seeks to describe potential risk factors for immune-related adverse events (irAEs) specifically among older adults. MATERIALS AND METHODS: This was a retrospective study at a single academic comprehensive cancer center based on chart review data abstracted by physicians. For patients aged ≥70 years, frequency, type, and grade of irAEs and their association with baseline patient demographics, comorbidities, mobility, and functional status were characterized using bivariate analysis. Based on those results, multivariable logistic regressions were constructed to model the association between these characteristics with any grade and grade 3 or higher irAEs. RESULTS: Data were analyzed for 238 patients aged ≥70 years who received IO for mostly (≥90%) advanced cancer between 2011 and 2018. Thirty-nine percent of older adults experienced an irAE and 13% experienced one that was grade 3 or higher. In the multivariable analysis, depression was associated with an increased incidence of any grade irAE, while decreased life-space mobility was associated with an increased incidence of grade ≥3 irAEs. CONCLUSION: Most characteristics of special interest among older adults, include fall risk, weight loss, cognitive limitations, and hearing loss, were not associated with irAEs in our study. However, decreased life-space mobility and depression are potential risk factors for IO toxicity among older adults with advanced cancer. Interventions designed to evaluate and mitigate modifiable risk factors for treatment-related toxicity are needed, and the results of this study may be useful for guiding those efforts.

摘要

目的:免疫检查点抑制剂免疫疗法(IO)正在彻底改变癌症治疗方法,但也可能导致严重的毒性。本研究旨在专门描述老年人中免疫相关不良事件(irAE)的潜在危险因素。

材料与方法:这是一项在单家学术综合癌症中心进行的回顾性研究,基于医生摘录的图表审查数据。对于年龄≥70 岁的患者,使用双变量分析描述 irAE 的频率、类型和等级及其与基线患者人口统计学、合并症、移动性和功能状态的关系。根据这些结果,构建多变量逻辑回归模型,以分析这些特征与任何等级和 3 级或更高等级 irAE 的关联。

结果:分析了 2011 年至 2018 年间接受 IO 治疗的 238 名年龄≥70 岁、主要患有晚期癌症(≥90%)的患者数据。39%的老年人经历了 irAE,13%的老年人经历了 3 级或更高等级的 irAE。在多变量分析中,抑郁与任何等级 irAE 的发生率增加有关,而生活空间移动能力下降与≥3 级 irAE 的发生率增加有关。

结论:在我们的研究中,大多数与老年人特别相关的特征,包括跌倒风险、体重减轻、认知障碍和听力损失,与 irAE 无关。然而,生活空间移动能力下降和抑郁可能是晚期癌症老年患者 IO 毒性的潜在危险因素。需要设计干预措施来评估和减轻与治疗相关毒性的可改变危险因素,本研究的结果可能有助于指导这些努力。

相似文献

[1]
Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer.

Oncologist. 2023-8-3

[2]
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[5]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
The Association of the Microbiome with Melanoma Tumor Response to Immune Checkpoint Inhibitor Treatment and Immune-Related Adverse Events (NCT05102773).

medRxiv. 2025-1-31

[2]
The Impact of Immune-Related Adverse Event Severity on Prognosis in Elderly Patients With Nonsmall-Cell Lung Cancer in First-Line Immune Checkpoint Inhibitor Treatment.

Thorac Cancer. 2025-2

[3]
Immunotherapy and Radiotherapy for Older Patients with Locally Advanced Non-Metastatic Non-Small-Cell Lung Cancer Who Are Not Candidates for or Decline Surgery and Chemotherapy: A Practical Proposal by the International Geriatric Radiotherapy Group.

Cancers (Basel). 2024-9-9

[4]
Geriatric Assessment in the Era of Targeted and Immunotherapy.

Drugs Aging. 2024-7

[5]
Real-World Prevalence and Tolerability of Immune-Related Adverse Events in Older Adults with Non-Small Cell Lung Cancer: A Multi-Institutional Retrospective Study.

Cancers (Basel). 2024-6-6

[6]
Safety of immune checkpoint inhibitors in patients aged over 80 years: a retrospective cohort study.

Cancer Immunol Immunother. 2024-5-11

本文引用的文献

[1]
Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.

Lancet. 2021-11-20

[2]
Psychological Symptom Trajectories and Non-Small Cell Lung Cancer Survival: A Joint Model Analysis.

Psychosom Med.

[3]
Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer: A Randomized Clinical Trial.

JAMA Oncol. 2021-11-1

[4]
Immunotherapy in Older Adults With Cancer.

J Clin Oncol. 2021-7-1

[5]
Functional Disability Among Older Versus Younger Adults With Advanced Non-Small-Cell Lung Cancer.

JCO Oncol Pract. 2021-6

[6]
Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer.

J Geriatr Oncol. 2021-6

[7]
Comparative assessment of manual chart review and ICD claims data in evaluating immunotherapy-related adverse events.

Cancer Immunol Immunother. 2021-10

[8]
A prospective cohort study on the safety of checkpoint inhibitors in older cancer patients - the ELDERS study.

ESMO Open. 2021-2

[9]
Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer.

J Clin Oncol. 2021-2-20

[10]
Outcomes associated with immune-related adverse events in metastatic non-small cell lung cancer treated with nivolumab: a pooled exploratory analysis from a global cohort.

Cancer Immunol Immunother. 2020-3-5

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