239 Efficacy and toxicity of single agent immune checkpoint inhibitors among adults with cancer aged ≥80 years: a multicenter international cohort study
Year: 2021
Type: conference-abstract
Abstract: Background Immune checkpoint inhibitors (ICIs) are approved by the U.S. Food&Drug Administration in over 17 tumor types. Older adult patients make up about a quarter of all cancer patients but are historically understudied in cancer clinical trials. ICIs are associated with immune-related adverse events (irAEs), which may be particularly morbid for older adult patients with underlying comorbidities and impaired functional status. In this study, we provide insight into the real-world safety and efficacy of ICIs among older adult patients (≥80 years) with cancer. Methods This is a multicenter, international retrospective study of tumor-agnostic older adult patients with cancer treated with single-agent ICIs between 2010–2019 from 18 academic centers in the U.S. and Europe. A cohort of 928 patients aged ≥80 years during treatment with ICI was assembled and analyzed to evaluate clinical outcomes and irAE patterns in older adult patients treated with single-agent ICIs. Results Median age at ICI initiation was 83.0 years (range 75.8–97.0). Most patients (86.9%) were treated with anti-PD-1 therapy. Among the full cohort, the three most common tumors were non-small cell lung cancer (NSCLC, 37.2%,n=345), melanoma (35.5%,n=329), and genitourinary (GU) tumors (16.5%,n=153). Objective response rates for patients with NSCLC, melanoma, and GU tumors were 32.2%, 39.3%, and 26.2%, respectively. Median progression-free survival (PFS) was 6.7 months (95%CI, 5.2–8.6) for patients with NSCLC, 11.1 months (95%CI, 8.9–16.0) for patients with melanoma, and 6.0 months (95% CI, 5.0–10.7) for patients with GU malignancy. Median overall survival (OS) was 10.9 months (95%CI, 8.6–13.1) for patients with NSCLC, 30.0 months (95%CI, 23.6–46.4) for patients with melanoma, and 15.0 months (95%CI 9.1–25.4) for GU patients (Figure 1A-C). Within histology-specific cohorts (NSCLC, melanoma and GU), clinical outcomes were similar across age subgroups (<85,85–89,>90). Among all patients (N=928), 41.3% experienced ≥1 irAE(s), including 12.2% reported to be grade (G)3–4. No irAE-related deaths occurred. The median time to irAE onset was 9.8 weeks; 57% occurred within the first 3 months after ICI initiation. ICI was discontinued due to irAEs in 16.1% patients. There was no significant difference in the rate of irAEs among patients age <85, 85–89, and ≥90 years (p=0.15). Despite similar rates of G3+ irAEs, ICIs were discontinued due to irAE more than twice as often among patients ≥90 years compared to patients <90 years (30.9% vs. 15.1%, p=0.008) (table 1). Conclusions ICIs are effective and generally well-tolerated among older patients with cancer. However, ICI discontinuation due to irAE is more frequent with increasing age.
Authors: Caroline Nebhan, Alessio Cortellini, Weijie Ma, Teja Ganta, Haocan Song, Fei Ye, Rebecca Irlmeier, Neha Debnath, Anwaar Saeed, Maluki Radford, Asrar Alahmadi, Akiva Diamond, Christopher Hoimes, Nikhil Ramaiya, Carolyn Presley, Dwight Owen, Sarah Abou Alaiwi, Amin Nassar, Biagio Ricciuti, Giuseppe Lamberti, Melissa Bersanelli, Chiara Casartelli, Sebastiano Buti, Paolo Marchetti, Raffaele Giusti, Marco Filetti, Vito Vanella, Domenico Mallardo, Shravanti Macherla, Tamara Sussman, Andrea Botticelli, Domenico Galetta, Annamaria Catino, Pamela Pizzutilo, Carlo Genova, Maria Giovanna Dal Bello, Foteini Kalofonou, Ella Daniels, Paolo Ascierto, David Pinato, Toni Choueiri, Douglas Johnson, Thomas Marron, Yinghong Wang, Abdul Rafeh Naqash
Institutions: Vanderbilt University Medical Center, University of L'Aquila, The University of Texas MD Anderson Cancer Center, Icahn School of Medicine at Mount Sinai, The University of Kansas Cancer Center, Case Western Reserve University, Duke Cancer Institute, The Ohio State University, Dana-Farber Cancer Institute, University of Bologna, University of Parma, Azienda Ospedaliera Sant'Andrea, East Carolina University, Cleveland Clinic, Sapienza University of Rome, Istituto Tumori Bari, University of Genoa, Ospedale Policlinico San Martino, Imperial College London, National Cancer Institute
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3213629588