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Efficacy and safety of immune checkpoint inhibitor immunotherapy in elderly cancer patients

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Abstract

Purpose

There is limited evidence on the efficacy and safety of anti-programmed cell death protein 1 (PD-1)-/anti-programmed death-ligand 1 (PD-L1)-based immunotherapy in the elderly, particularly those aged over 75 years.

Methods/patients

The clinical response and toxicity profile of anti-PD-1-/anti-PD-L1-based immunotherapy in patients aged over 75 years were assessed in this retrospective observational study conducted in the Medical Oncology Service of a tertiary level hospital. The associations among clinical responses, adverse events, and geriatric syndromes were evaluated.

Results

In total, 20 patients aged between 75 and 94 years were evaluated. Pembrolizumab and nivolumab were the most commonly used drugs. A clinical benefit (stable disease, partial response or complete response) was documented in 13 patients (65%). This proportion was 80% in patients aged between 75 and 79 years, and 50% in those aged over 79 years (p = 0.236). The adverse events were similar to those reported in younger patients. At least one clinical adverse event (cAE) and one laboratory adverse event (lAE) was reported in 75% and 55% of patients, respectively. Polypharmacy was observed for all patients and multi-morbidity in 95%. Patients without gait disorders showed more responses to immunotherapy. The number of lAEs was significantly associated with the number of commonly prescribed drugs (slope = 0.218, p = 0.010), the Eastern Cooperative Oncology Group score, and the number of cAEs.

Conclusions

The elderly can obtain benefits from anti-PD-1-/anti-PD-L1-based immunotherapy. The toxicity profile was similar to that reported in younger counterparts.

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Acknowledgements

The authors also wish to thank the patients who consented to participate and release their personal data for the scientific purposes of this research.

Funding

This research has not received any funds.

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Authors and Affiliations

  1. Medical Oncology Service, Hospital General Universitario Gregorio Maranón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain

    B. Fox, M. de Toro Carmena, R. Álvarez Álvarez, A. Calles Blanco, C. López López, S. Pérez Ramírez, J. Á. Arranz, M. Martín & I. Márquez-Rodas

  2. CIBERONC, Madrid, Spain

    M. Martín & I. Márquez-Rodas

Authors
  1. B. Fox
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  2. M. de Toro Carmena
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  3. R. Álvarez Álvarez
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  4. A. Calles Blanco
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  5. C. López López
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  6. S. Pérez Ramírez
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  7. J. Á. Arranz
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  8. M. Martín
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  9. I. Márquez-Rodas
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Contributions

All authors participated in the review and extraction of literature, design of the study, interpretation of results, and preparation of the manuscript. All authors had full access to the data and have provided their final approval of the version of the manuscript to be submitted for publication.

Corresponding author

Correspondence to B. Fox.

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Conflict of interest

Bárbara Fox has received educational fees from Pfizer, Eli Lilly and Company, Pierre Fabre, Kyowa Kirin, Bristol-Myers Squibb, Amgen. PharmaMar, and Mundipharma. María de Toro has received educational fees from Leo Pharma and Merck Sharp & Dohme. Rosa Álvarez Álvarez has received honorary/consulting fees from PharmaMar, Merrimack, AstraZeneca, Boehringer-Ingelheim, Jansen Oncology, Abbie, Pfizer, Roche/Genentech, Eli Lilly and Company, Novartis, Merck Sharp & Dohme, Bayer, Pierre Fabre, Peregrine Pharmaceuticals and Bristol-Myers Squibb. Antonio Calles Blanco has received honorary/consulting fees from AstraZeneca, Boehringer-Ingelheim, Pfizer, Roche/Genentech, Eli Lilly and Company, Novartis, Merck Sharp & Dohme, and Bristol-Myers Squibb. Cristina López López has received educational fees from Roche, Pfizer and Merck Sharp & Dohme. SPR has received fees from Sanofi, Bayer, Janssen-Cilag and Roche. José Ángel Arranz has received advisory awards from Bristol-Myers Squibb, Merck Sharp & Dohme and Pfizer; travel expenses coverage from Bristol-Myers Squibb, Merck Sharp & Dohme and Janssen-Cilag; and research funds from Bristol-Myers Squibb. Miguel Martín has received research grants from Roche and Novartis, consulting/advisory fees from AstraZeneca, Amgen, Taiho Oncology, Roche/Genentech, Novartis, PharmaMar, Eli Lilly, PUMA and Pfizer and speakers’ honoraria from AstraZeneca, Amgen, Roche/Genentech, Novartis, and Pfizer, Iván Márquez-Rodas has received grants as advisor from the following: Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche, Pierre Fabre, Amgen, AstraZeneca, Merck Serono, Incyte, Bioncotech Therapeutics S.L, and Sanofi.

Ethical approval

The Research Ethics Committee of Hospital General Universitario Gregorio Marañón approved the study protocol prior to its start.

Human and animal rights

The manuscript does not contain clinical studies or patient data.

Informed consent

Patients signed the written informed consent to participate in it.

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Fox, B., de Toro Carmena, M., Álvarez Álvarez, R. et al. Efficacy and safety of immune checkpoint inhibitor immunotherapy in elderly cancer patients. Clin Transl Oncol 22, 555–562 (2020). https://doi.org/10.1007/s12094-019-02161-4

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  • DOI: https://doi.org/10.1007/s12094-019-02161-4

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