Efficacy of immune checkpoint inhibitors in older adults with advanced stage cancers: A meta-analysis

Kasherman, Lawrence; Siu, Derrick Ho Wai; Lee, Kirsty; Lord, Sarah J.; Marschner, Ian C.; Lewis, Craig; Friedlander, Michael; Lee, Chee Khoon

doi:10.1016/j.jgo.2019.05.013

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…The correlations between patients’ age and cancer immunotherapy efficacy have been assessed by Wu et al, 12 who reported that patients aged 65 years or older benefited more from immunotherapy than younger patients. In contrast, Kasherman et al 13 suggested that ICIs improved overall survival (OS) for both younger and older patients, and the magnitude of OS improvement was age independent. To our knowledge, no study has assessed the association of ECOG PS with the relative benefit from immunotherapy in patients with advanced cancer.…”

Section: Introductionmentioning

confidence: 98%

Association of Sex, Age, and Eastern Cooperative Oncology Group Performance Status With Survival Benefit of Cancer Immunotherapy in Randomized Clinical Trials

et al. 2020

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IMPORTANCE Sex, age, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) may affect immune response. However, the association of these factors with the survival benefit of cancer immunotherapy with immune checkpoint inhibitors (ICIs) remains unclear. OBJECTIVE To assess the potential sex, age, and ECOG PS differences of immunotherapy survival benefit in patients with advanced cancer.

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Section: Introductionmentioning

confidence: 98%

Association of Sex, Age, and Eastern Cooperative Oncology Group Performance Status With Survival Benefit of Cancer Immunotherapy in Randomized Clinical Trials

et al. 2020

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“…Similarly, the elderly were expected to experience more immune-related adverse events (irAEs). However, meta-analyses of ICI treatment showed no significant difference in efficacy between the younger and older groups with cut-offs of 65, 70, and 75 years of age [ 21 , 22 ]. Frequency and severity of irAEs were also similar between the younger and elderly groups [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Complete remission in metastatic primary malignant melanoma of the esophagus with nivolumab: a case report

2021

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Background Primary malignant melanoma of the esophagus is a rare form of mucosal melanoma with a poor prognosis. While immune checkpoint inhibitors have recently extended overall survival in metastatic melanoma, data on their effects on primary malignant melanoma of the esophagus are limited because of its rarity. Here, we report the first case of long-term complete remission of metastatic primary malignant melanoma of the esophagus after nivolumab monotherapy. Case presentation A 79-year-old Asian man with a history of prostate cancer, gallbladder cancer, deep vein thrombosis, hypertension, and diabetes mellitus presented with gross hematuria. Cystoscopy revealed a solitary tumor on the right posterior wall of the bladder, and transurethral resection of bladder tumor was performed. Pathology was consistent with metastatic melanoma. A pigmented submucosal tumor-like growth in the esophagus was discovered on esophagogastroduodenoscopy. Computed tomography showed widespread metastases. The patient was diagnosed as having primary malignant melanoma of the esophagus with metastases to the stomach, subcutaneous tissue, lung, bladder, pleura, and peritoneum. Complete remission was achieved after seven cycles of triweekly nivolumab monotherapy. While nivolumab was discontinued because of kidney injury, the patient has remained tumor-free for over 4 years without further treatment. Conclusion Immune checkpoint inhibitors may have astonishing curative effects in selected populations. More research is warranted to identify factors that increase the likelihood of achieving complete remission in primary malignant melanoma of the esophagus as well as in other melanomas.

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“…Age affects host immunity and therefore could affect the effectiveness of ICI treatment. Although some meta-analyses have found that the therapeutic effect of ICI was independent of age (21,22,(43)(44)(45), these meta-analyses mainly focused on ICI monotherapy or total cancer treatment and did not specifically study the influence of age on ICI combined with other treatments in the context of NSCLC. To the best of our knowledge, this is the first meta-analysis to investigate the impact of age on the efficacy of ICI-based combination therapy vs. non-ICI therapy in NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Age on the Efficacy of Immune Checkpoint Inhibitor-Based Combination Therapy for Non-small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Tian

Han

2020

Front. Oncol.

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Background: Despite the acknowledged benefits of immune checkpoint inhibitor (ICI)-based combination therapy (either with other checkpoint inhibitors, chemotherapy, targeted therapy, or radiotherapy), little is known about the impact of age on the efficacy of ICI-based combination therapy in non-small-cell lung cancer (NSCLC) patients. We conducted a systematic review and meta-analysis to investigate the differences in the benefits of ICI-based combination therapy for NSCLC by age (cut-off age, 65 years). Methods: We systematically searched randomized controlled trials (RCTs) of ICI plus other therapies including other ICIs, chemotherapies, targeted therapies, or radiotherapies, in the PubMed, Embase, and Cochrane databases with available hazard ratios (HRs) and 95% confidence intervals (CIs) for death and disease progression according to patient age. The search deadline was May 25, 2020. First, we calculated the pooled HRs of younger and older patients based on the HRs from each trial. Second, we assessed the pooled ratio of HRs reported in older patients to the HRs reported in younger patients for progression or death by the random-effects model. An estimated pooled HR ratio was lower than 1 indicating a better effect in older patients and higher than 1 indicating a better effect in younger patients. Results: A total of 10 eligible RCTs were included in our meta-analysis. The pooled HR for overall survival (OS) comparing ICI combined with other therapies to non-ICI regimens was 0.67 (95%CI 0.58-0.78) for younger patients and 0.79 (95%CI 0.70-0.90) for older patients. The pooled HRs ratio for OS reported in older patients compared to younger patients was 1.16 (95%CI 0.99-1.34), indicating no statistically significant difference between younger and older patients. Consistent with the findings related to OS, the analysis also demonstrated that ICI-based immunotherapy could significantly prolong progression-free survival (PFS) in younger and older patients (HR = 0.55; 95% CI 0.47-0.66, and HR = 0.64; 95% CI 0.57-0.71). The same results could also be observed Yan et al. Age and ICI-Based Combination Therapy in the pooled HRs ratio for PFS (HR = 1.15, 95%CI 0.91-1.46) indicating comparable efficacy of ICI-based combination therapy in younger and older patients with NSCLC. Conclusion: ICI-based combination therapy vs. non-ICI treatment had comparable efficacy in younger and older NSCLC patients with a cutoff age of 65 years.

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Efficacy of immune checkpoint inhibitors in older adults with advanced stage cancers: A meta-analysis

Cited by 25 publications

References 19 publications

Association of Sex, Age, and Eastern Cooperative Oncology Group Performance Status With Survival Benefit of Cancer Immunotherapy in Randomized Clinical Trials

Association of Sex, Age, and Eastern Cooperative Oncology Group Performance Status With Survival Benefit of Cancer Immunotherapy in Randomized Clinical Trials

Complete remission in metastatic primary malignant melanoma of the esophagus with nivolumab: a case report

Impact of Age on the Efficacy of Immune Checkpoint Inhibitor-Based Combination Therapy for Non-small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

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