Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland, USA.
Department of Oncology, Johns Hopkins, Baltimore, Maryland, USA.
Can J Urol. 2024 Jun;31(3):11875-11879.
Immune checkpoint inhibitors (ICIs) are approved for advanced urothelial cancer alone and as first-line in combination with enfortumab vedotin. Platinum based chemotherapy which is another frontline choice is often not a treatment option for older patients due to comorbidities that increase with age. Despite ICIs being better tolerated compared to traditional chemotherapy little is known about their efficacy and toxicity in patients ≥ 90 years due to the rarity of this population in clinical trials. Our objective was to analyze the efficacy and toxicity of immune checkpoint inhibitors in patients ≥ 90 years.
We conducted a single center retrospective review of patients ≥ 90 years treated between July 2019 and September 2023 with standard of care ICIs for advanced urothelial cancer.
Six patients treated with pembrolizumab were identified. Four (66.7%) were male and mean age was 93.5 years at the time of treatment initiation. Response rate was 66.7% (4 patients) with 3 complete responses, which were durable off therapy. Median follow up was 18.2 months. Median progression free survival (PFS) was 10.2 months [95%confidence interval (95%CI): 1.77, not reached (NR)] and median overall survival (OS) was 18.2 months (95%CI: 12.1, NR). Side effects presented in 4 (66.7%) patients and included hypothyroidism, diarrhea, anemia, thrombocytopenia, rash, and bullous dermatitis. One patient developed grade 3 anemia and no patients experienced grade 4 events or required hospitalization due to treatment side effects.
Our experience in a small cohort of patients ≥ 90 years indicate that ICIs are well tolerated and effective for the treatment of advanced urothelial carcinoma in this patient population.
免疫检查点抑制剂（ICIs）已被批准单独用于晚期尿路上皮癌，也与恩福妥单抗 vedotin 联合用于一线治疗。由于年龄增长导致的合并症增加，基于铂的化疗是另一种一线选择，但对于老年患者来说，通常不是一种治疗选择。尽管与传统化疗相比，ICI 的耐受性更好，但由于临床试验中该人群的罕见性，对于 90 岁以上患者的疗效和毒性知之甚少。我们的目的是分析免疫检查点抑制剂在 90 岁以上患者中的疗效和毒性。
我们对 2019 年 7 月至 2023 年 9 月期间接受标准治疗 ICI 治疗的 90 岁以上晚期尿路上皮癌患者进行了单中心回顾性研究。
共确定了 6 名接受 pembrolizumab 治疗的患者。其中 4 名（66.7%）为男性，治疗开始时的平均年龄为 93.5 岁。客观缓解率为 66.7%（4 名患者），其中 3 名完全缓解，治疗后缓解持久。中位随访时间为 18.2 个月。中位无进展生存期（PFS）为 10.2 个月[95%置信区间（95%CI）：1.77，未达到（NR）]，中位总生存期（OS）为 18.2 个月（95%CI：12.1，NR）。4 名（66.7%）患者出现副作用，包括甲状腺功能减退、腹泻、贫血、血小板减少、皮疹和大疱性皮炎。1 名患者出现 3 级贫血，无患者因治疗副作用发生 4 级事件或需要住院治疗。
我们在一小部分 90 岁以上患者中的经验表明，ICI 对该患者人群的晚期尿路上皮癌治疗具有良好的耐受性和疗效。
