The use of immunotherapy in older patients with advanced non-small cell lung cancer

Tagliamento, Marco; Frélaut, Maxime; Baldini, Capucine; Naigeon, Marie; Nencioni, Alessio; Chaput, Nathalie; Besse, Benjamin

doi:10.1016/j.ctrv.2022.102394

Cited by 20 publications

(14 citation statements)

References 107 publications

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“…This study showed a lower ORR but a similar median OS compared to previously published RCTs (ORR: 4.3-22%; overall, 10.6%; DCR: 30.0-59.2%; overall, 46.7%) (Table 4). Age-related decline in the immune system, known as "immunosenescence," may affect immune checkpoint suppression activity in older patients [19,20]. In addition, many comorbidities may contribute to death from causes other than lung cancer in older adults [21,22].…”

Section: Discussionmentioning

confidence: 99%

Real-World Outcomes of Nivolumab, Pembrolizumab, and Atezolizumab Treatment Efficacy in Korean Veterans with Stage IV Non-Small-Cell Lung Cancer

Ham

Lee²,

Kim³

et al. 2023

Preprint

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In clinical settings, patients receiving immune checkpoint inhibitors (ICIs) have different treatment criteria from those enrolled in clinical trials. There are concerns regarding the efficacy of ICIs in older adults due to the age-associated decline in the immune system, and no study has directly compared the efficacy of different ICIs in a real-world setting. We aimed to analyze ICIs use and treatment outcomes in Korean veterans with stage IV non-small-cell lung cancer (NSCLC). In total, 180 patients diagnosed with stage IV NSCLC between 2016 and 2021 were included in this analysis. Three cohort groups were derived based on ICI type (pembrolizumab, nivolumab, and atezolizumab treatment groups), and their clinical characteristics and survival outcomes were compared. The predictors of survival outcomes in patients with NSCLC were investigated using a Cox regression model. The objective response rate (ORR) was 22.4%, 8.2%, and 4.3% in the pembrolizumab, nivolumab, and atezolizumab groups, respectively, whereas the disease control rate (DCR) was 59.2, 55.7%, and 30.0%, respectively. There was no difference in the overall survival (OS) rate among the groups, and no treatment-specific OS benefit was observed relative to tumor PD-L1 expression, and bone metastasis was a poor prognostic factor for OS. Pembrolizumab and nivolumab were associated with a significant increase in ORR and DCR compared with atezolizumab, and there was no statistically significant difference in survival outcomes among the three ICIs, demonstrating that they may be an appropriate treatment option for older patients.

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Section: Discussionmentioning

confidence: 99%

Real-World Outcomes of Nivolumab, Pembrolizumab, and Atezolizumab Treatment Efficacy in Korean Veterans with Stage IV Non-Small-Cell Lung Cancer

Ham

Lee²,

Kim³

et al. 2023

Preprint

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“…Despite some concerns regarding the immune system in older adults, favorable responses and adequate tolerability of IO drugs have been reported in older patients with melanoma and non-small cell lung cancer [19][20][21]. Although some studies have reported that the mutational load of cancer cells can increase in an age-dependent manner [22], others have shown that advanced age is also associated with increased production of pro-in ammatory cytokines and autoantibodies, which might lead to subclinical autoimmune diseases in the older population [23].…”

Section: Discussionmentioning

confidence: 99%

Real clinical outcomes of nivolumab plus ipilimumab for renal cell carcinoma in patients over 75 years old

et al. 2023

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BackgroundAlthough nivolumab plus ipilimumab is the standard treatment for metastatic renal cell carcinoma (RCC), its e cacy and safety in older patients remain unclear. Therefore, this study aimed to assess the clinical outcomes of nivolumab plus ipilimumab for metastatic RCC in patients aged ≥ 75 years. MethodsWe enrolled 120 patients with metastatic RCC treated with nivolumab plus ipilimumab from August 2015 to January 2023. Objective response rates (ORRs) were compared between patients aged < 75 and ≥ 75 years. Progression-free survival (PFS), overall survival (OS), and adverse events were compared between the groups. Adverse events were evaluated according to the Response Evaluation Criteria in Solid Tumors 1.1. ResultsAmong the patients, 57 and 63 were classi ed as intermediate and poor risk, respectively, and one could not be classi ed. The median follow-up duration after the initiation of treatment was 16 months. The patient characteristics between the groups, except for age, were not signi cantly different. Intergroup differences in ORR (42% vs. 40%; p = 0.818), PFS (HR: 0.820, 95% CI: 0.455-1.479; p = 0.510), and median OS (HR: 1.492, 95% CI: 0.737-3.020; p = 0.267) were not signi cant. The incidence of adverse events (50% vs. 67%; p = 0.111) and nivolumab plus ipilimumab discontinuation due to adverse events was not signi cantly different between the groups (14% vs. 13%; p = 0.877). ConclusionsThe effectiveness of nivolumab plus ipilimumab was comparable between patients with metastatic RCC aged < 75 and those ≥ 75 years with respect to their ORRs, PFS, OS, and adverse event rates.

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“…Around 30–40% of new cases of advanced NSCLC are detected in population older than 70 years and nearly 15% of cases afflict people aged ≥ 80 years. The vast majority of these patients at the time of diagnosis, are inoperable [ 44 , 45 ]. Based on the characteristics of the subjects and of the disease, it can be opted between a curative or a palliative approach.…”

Section: Metronomic Chemotherapy In Elderly Non-small Cell Lung Cance...mentioning

confidence: 99%

Metronomic Chemotherapy in Elderly Patients

Bandini,

Calabrò,

Banchi

et al. 2024

Curr Oncol Rep

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Purpose of Review This review describes the most relevant studies found in the scientific literature regarding metronomic chemotherapy (MCT) in the geriatric oncology population to support its use as a feasible treatment of care in the frail elderly patients. Recent Findings Recent years have seen a reevaluation of cancer chemotherapeutic drugs and MCT is an emerging schedule in phase II and III clinical trials. Summary Ageing is one of the risk factors for the development of cancer, the incidence of whom increases dramatically in people who live longer. To date, standard oncological protocols involve chemotherapeutic drugs in short cycles of therapy at the maximum tolerated dose (MTD). Although these therapeutic regimens may be successful, they can cause important adverse drug reactions, especially in elderly or frail patients. MCT is a different modality of delivery of chemotherapeutic drugs (frequent low dose for prolonged time) and it looks at the overcoming of the limitations and disadvantages of MTD, in particular the toxicity aspect. We reviewed the experience of clinicians who have used MCT in clinical trials enrolling elderly patients with different cancer types.

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The use of immunotherapy in older patients with advanced non-small cell lung cancer

Cited by 20 publications

References 107 publications

Real-World Outcomes of Nivolumab, Pembrolizumab, and Atezolizumab Treatment Efficacy in Korean Veterans with Stage IV Non-Small-Cell Lung Cancer

Real-World Outcomes of Nivolumab, Pembrolizumab, and Atezolizumab Treatment Efficacy in Korean Veterans with Stage IV Non-Small-Cell Lung Cancer

Real clinical outcomes of nivolumab plus ipilimumab for renal cell carcinoma in patients over 75 years old

Metronomic Chemotherapy in Elderly Patients

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