Immunotherapy benefits older patients with cancer, but closer monitoring may be warranted
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Older patients with cancer benefited from single-agent immune checkpoint inhibitors but had higher rates of adverse events and therapy discontinuation with increasing age, according to results of a retrospective study in JAMA Oncology.
The findings suggest older adults, particularly those aged 90 years or older, may have a lower threshold for toxicities and warrant closer monitoring while receiving immunotherapy, according to Abdul Rafeh Naqash, MD, assistant professor of medicine in medical oncology and the TSET phase 1 program at Stephenson Cancer Center at The University of Oklahoma.
“We found that patients over age 80 [years] had promising and comparable treatment response and survival, and no significant difference in side effects, compared with previously reported outcomes for younger populations with similar cancers. This suggests that certain elements of the immune system maintain integrity even as we age,” Naqash told Healio.
Limited data exists on immunotherapy outcomes among patients with cancer aged older than 75 years, a population historically underrepresented in clinical trials.
“This creates a barrier to understanding how the outcomes in this patient population compare with a younger age group, and we often have to rely on extrapolating data from younger patients,” Naqash told Healio.
The analysis by Naqash and colleagues included 928 patients with cancer aged 80 years and older (median age, 83 years; range, 75-97) treated with single-agent immunotherapies at 18 academic medical centers across the United States and Europe between 2010 and 2019.
Malignancies included non-small cell lung cancer (37.2%), melanoma (35.5%) and genitourinary cancers (16.5%), including those of the prostate, bladder and kidney.
Researchers assessed clinical outcomes and immune-related adverse event patterns.
Results showed no significant difference in the rate of immune-related adverse events among patients aged younger than 85 years, 85 to 89 years, and 90 years or older. Researchers reported 383 patients (41.3%) experienced one or more immune-related adverse events, and 113 (12.2%) experienced grade 3 to grade 4 adverse events. Median time to immune-related adverse event onset was 9.8 weeks, and most events (57%) occurred within 3 months of immune checkpoint inhibitor initiation.
About 16% of patients discontinued treatment due to immune-related adverse events, and such discontinuation appeared twice as common among patients aged 90 years or older vs. patients aged younger than 90 years (30.9% vs. 15.1%, P = .008) despite similar rates of grade 3 or higher events between the groups.
Patients with melanoma had the highest objective response rate compared with patients with non-small cell lung cancer and genitourinary tumors (39.3% vs. 32.2% vs. 26.2%), as well as longer median PFS (11.1 months vs. 6.7 months vs. 6 months) and median OS (30 months vs. 10.9 months vs. 15 months).
Naqash told Healio the results represent a “proof of principle” approach that can help generate preliminary data in this patient population.
“Such data can help drive future clinical trials in this space and encourage participation of such underrepresented groups wherever and whenever possible to drive promising therapeutic approaches,” he said. “Subsequent studies in this age group will be instrumental in generating data physicians can use to make treatment decisions that are age appropriate, rather than merely rely on data extrapolation drawn from younger populations.”
For more information:
Abdul Rafeh Naqash, MD, can be reached at Medical Oncology/TSET phase 1 program, Stephenson Cancer Center, University of Oklahoma, 800 NE 10th St., Oklahoma City, OK 73104; email: abdulrafeh-naqash@ouhsc.edu.
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