Immune Checkpoint Inhibitors in Older Adults

Elias, Rawad; Morales, Joshua; Rehman, Yasser; Khurshid, Humera

doi:10.1007/s11912-016-0534-9

Cited by 53 publications

(39 citation statements)

References 32 publications

(19 reference statements)

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“…Elderly patients reported the worst scores. Though recent data would suggest elderly patients do not demonstrate an increased risk of incurring irAEs compared with the remainder of the population, there remains the possibility that they possess reduced physiological reserve and thus toxicity may result in a greater impact on HRQoL [27,28]. The elderly population is not well represented in previous reports of HRQoL or the clinical trial setting in general [27,29].…”

Section: Discussionmentioning

confidence: 99%

An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

O’Reilly

Hughes

Mann

et al. 2019

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Purpose The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achieving high-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aim of this study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-related adverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK. Methods We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durable response to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression. HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEs and survival. HRQoL data was compared with two norm-based datasets. Results Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity of any grade occurred in 92% of patients and 43% had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients required steroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyond steroids. Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical role functioning and general health compared with the normative population. There was a trend towards inferior scores in patients with previous exposure to ipilimumab compared with those never exposed to ipilimumab. Conclusions Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicity and experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population's unique survivorship needs.

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Section: Discussionmentioning

confidence: 99%

An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

O’Reilly

Hughes

Mann

et al. 2019

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“…Cancer is a disease of the elderly with more than 50% of new cases occurring in adults older than 65 years [23]. And in fact, the care of the elderly is more complicated than the young or middle age people, due to gradual organ dysfunction, slow drug reaction or many concomitant diseases.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of immune checkpoint inhibitors in non-small cell lung cancer patients of different age groups: a meta-analysis

et al. 2019

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Background Age is closely related to the efficacy of treatment for non-small cell lung cancer (NSCLC) patients. Latest clinical trials have proved the better overall survival (OS) for the use of immune checkpoint inhibitors verse chemotherapy in NSCLC patients. However, we had no clear idea of the efficacy of them in elderly patients. So we conducted a meta-analysis to compare the efficacy of immune checkpoint inhibitors for NSCLC patients of different age groups and summarized overall treatment-related adverse events. Materials and methods PubMed, EMBASE, Web of Science and the Cochrane Library were searched for all clinical trials in NSCLC until 30th of April 2019. Eligible studies included randomized controlled trials (RCTs) comparing immune checkpoint inhibitors with chemotherapy in NSCLC patients. The hazard ratio (HRs) and 95% confidence intervals (CIs) of OS, progression-free survival or adverse events (AEs) were used. Results A total of 4994 patients from 8 RCTs were included. Immune checkpoint inhibitors significantly prolonged the OS (HR, 0.73; 95% CI, 0.61-0.89) versus chemotherapy in NSCLC patients who were less than 65 years old. Also, they prolonged the OS (HR, 0.74; 95% CI, 0.59-0.93) in NSCLC patients who were more than 65 years old. However, there was no statistical significance of OS (HR, 0.87; 95% CI, 0.57-1.30) among NSCLC patients who were more than 75 years old. It also showed that the single use of immune checkpoint inhibitors had fewer all-grade AEs. Conclusion Regardless of the NSCLC patients who were less or more than 65 years, immune checkpoint inhibitors could achieve better OS than chemotherapy. But there was no significant difference when NSCLC patients who were more than 75 years old. Older patient should be offered immune therapies if it is possible and the mechanism in old age treatment should be further studied.

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“…[8] In KEYNOTE-006, pembrolizumab dosed every 2 weeks or 3 weeks was associated with a HR of 0.56 (0.36 – −0.87) and 0.66 (0.44 – −1.01) respectively when compared to ipilimumab. [23] As for the combination of nivolumab plus ipilimumab, in CheckMate 069 the objective response rate was 64% in patients younger than 65 years compared to 53% in those aged 65 and older. [24] The FDA now requires the inclusion of a Geriatric Use subsection in the labeling for prescription drugs to provide relevant information for clinicians about the use of those products in older adults.…”

Section: What Is Known About Using Immunotherapy In the Older Adultmentioning

confidence: 99%

Checkpoint inhibition and melanoma: Considerations in treating the older adult

Friedman

Wolchok

2017

Journal of Geriatric Oncology

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The incidence of melanoma and associated mortality rate from advanced disease in older adults is increasing over time. Checkpoint inhibitors have demonstrated a survival benefit for the treatment of stage IV or unresectable stage III disease and have become one of the standards of care. Data suggests that adults aged 65 and older benefit from treatment with checkpoint inhibitors without an increased incidence in adverse events. However, clinicians should be aware of the potential side effects of this class of medications and how to manage them in older adults.

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Immune Checkpoint Inhibitors in Older Adults

Cited by 53 publications

References 32 publications

An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

The efficacy and safety of immune checkpoint inhibitors in non-small cell lung cancer patients of different age groups: a meta-analysis

Checkpoint inhibition and melanoma: Considerations in treating the older adult

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