Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
Department of Pharmacy, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
Sci Rep. 2024 Aug 16;14(1):18992. doi: 10.1038/s41598-024-69944-w.
Immune checkpoint inhibitors (ICIs) have become an important cornerstone of many tumour treatments. However, the toxicity profile of immune-chemotherapy combination treatment approaches among older adult cancer patients is still unclear. Patients with any cancer who received camrelizumab-based immunotherapy were eligible for inclusion. The primary endpoints were adverse events (AEs) and immune-related adverse events (irAEs), which were defined based on Naranjo's algorithm. Patients were stratified by age (≥ 70 years and < 70 years), and comparisons were made based on the type of camrelizumab-based therapy (monotherapy, combined chemotherapy, or combined anti-VEGF therapy). A total of 185 patients were administered camrelizumab-based immunotherapy, 55 (30%) of whom were ≥ 70 years old. A total of 146 (78.9%) patients received camrelizumab-based combination treatment. The incidence of all-grade AEs was 56.8% (105 patients), while that of irAEs was 36.8% (68 patients). There was no difference in the percentage of patients experiencing any grade or grade ≥ 3 AEs between age groups. However, the frequency of irAEs (both any grade and grade ≥ 3) significantly differed by age group (P = 0.001 and 0.009, respectively). The results of multivariable analysis revealed that age ≥ 70 years was the only independent risk factor for irAEs. The results of subgroup analysis revealed that the incidence of irAEs was higher in older patients treated with camrelizumab-chemotherapy, while the incidence rates were similar between age groups in the monotherapy and combination anti-VEGF treatment subgroups. Immune-related diabetes mellitus occurred more frequently among older adults. The spectrum of irAEs showed that combination immunotherapy had more widely effects on the organ system than monotherapy. In this study, older (≥ 70 years) patients had a higher risk of all-grade and high-grade irAEs when receiving camrelizumab chemotherapy combination treatment. Notably, long-term random glucose monitoring should be performed during ICI-based immunotherapy in older cancer patients.
免疫检查点抑制剂（ICIs）已成为许多肿瘤治疗的重要基石。然而，老年癌症患者接受免疫化疗联合治疗方案的毒性特征仍不清楚。任何癌症患者接受卡瑞利珠单抗为基础的免疫治疗均符合纳入条件。主要终点是不良事件（AEs）和免疫相关不良事件（irAEs），根据 Naranjo 算法定义。患者按年龄分层（≥70 岁和<70 岁），并根据卡瑞利珠单抗为基础的治疗类型（单药、联合化疗或联合抗 VEGF 治疗）进行比较。共 185 例患者接受了卡瑞利珠单抗为基础的免疫治疗，其中 55 例（30%）年龄≥70 岁。共 146 例（78.9%）患者接受了卡瑞利珠单抗联合治疗。所有级别的 AEs 发生率为 56.8%（105 例），irAEs 发生率为 36.8%（68 例）。两组患者发生任何级别或≥3 级 AEs 的比例无差异。然而，irAEs（任何级别和≥3 级）的发生率按年龄组显著不同（P=0.001 和 0.009）。多变量分析结果显示，年龄≥70 岁是 irAEs 的唯一独立危险因素。亚组分析结果显示，卡瑞利珠单抗联合化疗治疗的老年患者 irAEs 发生率较高，而单药和联合抗 VEGF 治疗亚组两组之间的发生率相似。免疫相关性糖尿病在老年人中更为常见。irAEs 的谱表明，联合免疫治疗对器官系统的影响比单药更广。在这项研究中，接受卡瑞利珠单抗化疗联合治疗的老年（≥70 岁）患者发生所有级别和高级别 irAEs 的风险更高。值得注意的是，在老年癌症患者接受基于 ICI 的免疫治疗期间，应进行长期随机血糖监测。
