Guo Alyssa A, Knapp Mary-Peyton, Evans Joni K, Faucheux Andrew T, Price Sarah N, Klepin Heidi D, Levine Beverly, Quattlebaum Alexander, Bloomer Chance, Khoury Lara, Hunting John C, Elko Catherine A, Olson Eric, Lycan Thomas W
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Future Oncol. 2025 Jun;21(14):1787-1796. doi: 10.1080/14796694.2025.2502313. Epub 2025 May 27.
Nearly half of patients with cancer are diagnosed at 70 years or older, which presents challenges in cancer care due to their high comorbidity burden and the underrepresentation of this age group in clinical trials. This retrospective study evaluated the association between comorbidity burden and immune checkpoint inhibitors (ICIs) treatment outcomes among older adults.
Data were collected from patients aged 70 years or older at the time of diagnosis who were treated with ICIs from 2011 to 2022. Key clinical outcomes include changes in performance status, overall survival (OS), progression-free survival (PFS), and immune-related adverse events (irAEs) and were compared between low baseline Charlson Comorbidity Index (CCI) and high CCI (<4 vs. ≥4) groups.
Among 1,223 patients, patients with CCI scores ≥4 ( = 300) had a significantly shorter OS (11.4 vs. 13.6 months, = 0.0461) but similar PFS (8.0 vs. 7.7 months, = 0.258) compared to patients with CCI scores <4. There was no significant difference in changes in performance status pre- and post-treatment ( = 0.14) or in the irAE prevalence between the two groups (39.3% vs. 38.3%, = 0.786).
Our study suggests that ICIs are safe in patients with high comorbidity burden but that the presence of pre-treatment comorbidities decreases overall survival.
近一半的癌症患者在70岁及以上被诊断出患有癌症，由于其高合并症负担以及该年龄组在临床试验中的代表性不足，这给癌症护理带来了挑战。这项回顾性研究评估了老年患者合并症负担与免疫检查点抑制剂（ICI）治疗结果之间的关联。
收集了2011年至2022年期间接受ICI治疗的70岁及以上诊断时患者的数据。关键临床结果包括体能状态变化、总生存期（OS）、无进展生存期（PFS）和免疫相关不良事件（irAE），并在低基线Charlson合并症指数（CCI）组和高CCI组（<4 vs.≥4）之间进行比较。
在1223例患者中，CCI评分≥4（n = 300）的患者与CCI评分<4的患者相比，OS显著缩短（11.4个月对13.6个月，P = 0.0461），但PFS相似（8.0个月对7.7个月，P = 0.258）。两组治疗前后体能状态变化（P = 0.14）或irAE患病率（39.3%对38.3%，P = 0.786）无显著差异。
我们的研究表明，ICI在合并症负担高的患者中是安全的，但治疗前合并症的存在会降低总生存期。
