Elderly patients and PD-L1-positive advanced non-small cell lung cancer: is pembrolizumab monotherapy effective and safe?

Gridelli, Cesare; Sgambato, Assunta

doi:10.21037/atm.2019.12.31

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…In addition, grade 3 or 4 treatment-related adverse effects with anti-PD-1/PD-L1 mAbs were less frequent in patients ≥75 years (23%) when compared to patients 65-74 years (49%) and <65 years (47%) (67). Overall, this data and other studies support the use of pembrolizumab as monotherapy in elderly patients with PD-L1 >0% NSCLC, as it has a better OS and more favorable safety profile when compared to chemotherapy (63,(67)(68)(69)(70)(71).…”

Section: Immunotherapy In the Elderlysupporting

confidence: 59%

“…The elderly population’s representation in clinical trials is biased due to selection of relatively healthy elderly individuals to meet clinical trial inclusion criteria. Clinical trials generally require their selected patients to have little to no comorbidities, which is not representative of the general elderly population ( 69 , 78 ). Clinical trials should consider using assessments such as the CGA to more properly measure whether or not an elderly person is able to be included in the study, as our current performance scores are not felt to properly capture the true functional status of our older adult patients.…”

Section: Using Geriatric Assessmentsmentioning

confidence: 99%

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Narrative review of immunotherapy and radiation therapy in elderly patients

Chau¹,

LaGuardia²,

Hui³

et al. 2021

Transl Cancer Res TCR

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Cancer is primarily a disease of the elderly, but there is a disproportionate lack of data from clinical trials in this population. Oncologists tend to underdiagnose and undertreat geriatric patients with cancer, leading to poor survival outcomes. New therapies or therapeutic combinations such as immunotherapy and stereotactic body radiation therapy (SBRT) can be used in the elderly for better tumor control and survival, with fewer toxicities. The aim of this review is to describe the synergistic effects of immunotherapy and radiation therapy (RT) and to discuss the use of these therapies concurrently and/ or sequentially in the elderly. To gain a fuller picture of their elderly patient's health, physicians may also consider incorporating a comprehensive geriatric assessment (CGA) to evaluate their functional capacity, cognition, physical and mental health, and social supports which we will discuss in this review. It is recommended that oncologists use geriatric assessments in their everyday practice to have better insight on their complex elderly patients, therefore providing them a higher quality of care. They should also be incorporated in clinical trials as a way to assess and include more elderly patients in the study. Ultimately, the elderly deserve to be treated with more than their chronological age in mind, and new combination therapies and use of a geriatric assessment can help achieve that.

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Section: Immunotherapy In the Elderlysupporting

confidence: 59%

Section: Using Geriatric Assessmentsmentioning

confidence: 99%

Narrative review of immunotherapy and radiation therapy in elderly patients

Chau¹,

LaGuardia²,

Hui³

et al. 2021

Transl Cancer Res TCR

View full text Add to dashboard Cite

show abstract

“…Additionally, we treated age as a dichotomous variable for the purpose of our analysis, while in reality it is continuous. However, this is standard practice among similar studies [8,12].…”

Section: Discussionmentioning

confidence: 99%

“…Older adults carry a large burden of lung cancer rates, with most lung cancer being diagnosed between age 65-74 and a median age at diagnosis of about 70 years old [7]. Despite this, older adults are often underrepresented in lung cancer clinical trials, and even outside of trial settings there are limited data on the use of immunotherapy in older adults [8]. Additionally, there are concerns that older adults may be more vulnerable to treatment-related toxicities, with conflicting data on whether older adults experience more frequent or severe toxicities from immunotherapy [9].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of First-Line Pembrolizumab in Older Adults with PD-L1 Positive Non-Small Cell Lung Cancer: A Retrospective Cohort Study of the Alberta Immunotherapy Database

et al. 2021

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The emergence of immunotherapy revolutionized the treatment of non-small-cell-lung cancer (NSCLC), with multiple landmark clinical trials establishing the efficacy of these agents. However, many patients who receive immunotherapy in clinical practice would be considered clinical trial ineligible. One such population that is often under-represented in clinical trials is older adults. In the current study, we evaluated clinical and safety outcomes in this population. Overall, older adults (>70 years of age) and younger adults had comparable clinical outcomes with an equivalent objective response rate (ORR), time to treatment failure (TTF), and median overall survival (p = 0.67, p = 0.98, and p = 0.91, respectively). Furthermore, the safety outcomes were equivalent between the cohorts with similar rates of immune-related adverse events (irAEs), irAE-related hospitalizations, and all-cause hospitalization (p = 0.99, p = 0.63, and p = 0.74, respectively). While older age was not found to impact overall survival, multivariant analysis revealed that a poor Eastern Cooperative Oncology Group (ECOG) status, low body-mass-index (BMI), and poor/intermediate lung immune prognostic index (LIPI) were all associated with worse survival. In conclusion, age does not impact the efficacy or safety of pembrolizumab in NSCLC, and therefore advanced age should not be a deterrent for treating these patients with pembrolizumab. Physicians and care providers can thus focus on other factors that may influence therapeutic outcomes.

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