Management of immunotherapy toxicities in older adults

Bhandari, Shruti; Gill, Amitoj; Perez, Cesar A.; Jain, Dharamvir

doi:10.1053/j.seminoncol.2018.09.001

Cited by 25 publications

(29 citation statements)

References 45 publications

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“…For anti-PD-1 treatment, a retrospective study by Betof et al showed no difference in OS or PFS in patients with metastatic melanoma, comparing patients aged ≥ 75 years with younger patients [19]. However, only 20–40% of patients included in these trials are aged > 65 years[20], while 45% of the general melanoma population is aged > 65 years [1]. The older patients included in these trials are probably not representative for the general population of patients with cancer because of selective inclusion criteria, such as a good performance status, normal hepatic and renal function, and no autoimmune disease.…”

Section: Treatment Efficacy Of Immune Checkpoint Inhibitors In Older mentioning

confidence: 99%

“…The spectrum of toxicities seen in CTLA-4 inhibitors or PD-1/PD-L1 inhibitors is similar, but frequencies differ. In general, CTLA-4 inhibitors have shown more grade 3–4 irAEs than PD-1/PD-L1 inhibitors [20, 30]. In addition, the combination of anti-CTLA-4 and PD-1/PD-L1 blockade for metastatic melanoma can cause treatment-related adverse events in 95% of patients, with grade 3 or higher events in 55% of patients [31].…”

Section: Immune-related Adverse Events In Older Patientsmentioning

confidence: 99%

“…Previous studies have reported irAEs in 60–86% of patients of all ages using ipilimumab (CTLA-4 inhibitor). Around 20–41.6% of patients develop grade 3 and 4 toxicities, depending on dose [20, 30, 32]. The most frequently observed toxicities (> 10%) are diarrhea, rash, pruritus, fatigue, nausea, vomiting, anorexia and abdominal pain [20, 30].…”

Section: Immune-related Adverse Events In Older Patientsmentioning

confidence: 99%

“…For nivolumab, 58–85% of patients of all ages reported irAEs, of which 7–20% were grade 3 and 4 toxicities, depending on tumour localisation. For pembrolizumab, 57–80% of patients reported irAEs, of which 10–26% were grade 3 and 4 toxicities, depending on dose [20, 30, 32]. The most commonly observed toxicities (> 10%) are fatigue, rash, pruritus, diarrhoea, nausea and arthralgia [20, 30].…”

Section: Immune-related Adverse Events In Older Patientsmentioning

confidence: 99%

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Efficacy and Adverse Events of Immunotherapy with Checkpoint Inhibitors in Older Patients with Cancer

et al. 2019

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The number of older patients with cancer is increasing as a result of the ageing of Western societies. Immune checkpoint inhibitors have improved cancer treatment and are associated with lower rates of treatment-related toxicity compared with chemotherapy in the general population. Nonetheless, immune checkpoint inhibitors have potentially serious immune-related adverse events, which might have a greater impact on older and more vulnerable patients and potentially influence treatment efficacy and quality of life. Previous clinical trials have shown no major increase in immune-related adverse events; however, older patients are underrepresented and relatively healthy in these trials. Observational studies suggest that older and more vulnerable patients may be at a higher risk of immune-related adverse events and early treatment discontinuation. Geriatric assessment could help identify older patients who will benefit from immune checkpoint inhibitors.

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Section: Treatment Efficacy Of Immune Checkpoint Inhibitors In Older mentioning

confidence: 99%

Section: Immune-related Adverse Events In Older Patientsmentioning

confidence: 99%

Section: Immune-related Adverse Events In Older Patientsmentioning

confidence: 99%

Section: Immune-related Adverse Events In Older Patientsmentioning

confidence: 99%

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Efficacy and Adverse Events of Immunotherapy with Checkpoint Inhibitors in Older Patients with Cancer

et al. 2019

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“…Nevertheless, a large proportion of ICB-treated cancer patients still do not benefit from these drugs. Thus, while initial ICB targets have led to an immunological resurgence in oncology, this lack of widespread clinical benefit together with the occurrence of immune related adverse events (irAEs), principally due to the onset of autoimmune reactions [12][13][14][15][16][17], have focused attention on alternative inhibitory immune checkpoint molecules, including lymphocyte activation gene 3 (LAG3, CD223), T cell immunoglobulin mucin 3 (TIM3) [18], adenosine A2A receptor (A2AR) [19], indoleamine-pyrrole 2,3-dioxygenase (IDO) [20], T cell immunoreceptor with Immunoglobulin and ITIM domains (TIGIT) [21], CD96 [22] and many others [23].…”

Section: Introductionmentioning

confidence: 99%

LAG3: The Biological Processes That Motivate Targeting This Immune Checkpoint Molecule in Human Cancer

Solinas

Migliori

Silva

et al. 2019

Cancers

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The programmed cell death 1 (PD-1) pathway is an important regulator of immune responses in peripheral tissues, including abnormal situations such as the tumor microenvironment. This pathway is currently the principal target for immunotherapeutic compounds designed to block immune checkpoint pathways, with these drugs improving clinical outcomes in a number of solid and hematological tumors. Medical oncology is experiencing an immune revolution that has scientists and clinicians looking at alternative, non-redundant inhibitory pathways also involved in regulating immune responses in cancer. A variety of targets have emerged for combinatorial approaches in immune checkpoint blockade. The main purpose of this narrative review is to summarize the biological role of lymphocyte activation gene 3 (LAG3), an emerging targetable inhibitory immune checkpoint molecule. We briefly discuss its role in infection, autoimmune disease and cancer, with a more detailed analysis of current data on LAG3 expression in breast cancer. Current clinical trials testing soluble LAG3 immunoglobulin and LAG3 antagonists are also presented in this work.

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Current Understanding and Future Perspectives on Hyperprogressive Disease Highlight the Tumor Microenvironment

Zhong

et al. 2022

The Journal of Clinical Pharma

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Cancer immunotherapy with immune checkpoint inhibitors has revolutionized traditional cancer therapy. Although many patients have achieved long‐term survival benefits from treatment with immune checkpoint inhibitors, there are still some patients who develop rapid tumor progression after immunotherapy, known as HPD. Here, we summarize the current knowledge on HPD after treatment with immune checkpoint inhibitors to promote a more thorough understanding of the disease. This review focuses on multiple aspects of HPD, especially the tumor microenvironment, with the hope that more reliable biomarkers and therapeutics will be established for HPD in the future.

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Management of immunotherapy toxicities in older adults

Cited by 25 publications

References 45 publications

Efficacy and Adverse Events of Immunotherapy with Checkpoint Inhibitors in Older Patients with Cancer

Efficacy and Adverse Events of Immunotherapy with Checkpoint Inhibitors in Older Patients with Cancer

LAG3: The Biological Processes That Motivate Targeting This Immune Checkpoint Molecule in Human Cancer

Current Understanding and Future Perspectives on Hyperprogressive Disease Highlight the Tumor Microenvironment

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