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Cancer Immunotherapies: Are They as Effective in the Elderly?

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Abstract

Almost two-thirds of all new cancer diagnoses are made in persons over the age of 65 years, yet it is unclear if age affects patient responsiveness to immunotherapy, which is increasingly becoming first-line therapy in advanced stages of different tumor types. Preclinical animal studies may be difficult to translate into humans since they frequently use young mice (2–3 months of age) equivalent to adolescent human subjects. Nevertheless, ex vivo studies from humans are concordant with mice tissue findings—older patients have an increased density of circulating regulatory immune cells and a decreased ratio of naïve-to-memory T cells. A review of different immunotherapy trials reveals that contrary to expectations, advanced age generally does not hinder safety and clinical response to different treatment modalities. A growing number of immune checkpoint inhibitor immunotherapy trials have been published with basic safety and clinical response data stratified by age. We present the clinical response data from 21 phase II/III clinical trials based on age stratification into young and old subgroups. Data from these trials indicate that these agents have an overall low toxicity profile and that they are similarly well-tolerated in young and old patient subgroups. However, drug-specific differences exist for immune checkpoint inhibition in elderly subjects when comparing overall survival and progression-free survival hazard ratios with those of young subjects. Additional work is needed to better stratify ‘responders’ and ‘nonresponders’ within the elderly age group in order to optimize immunotherapy use in a heterogeneous patient population.

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Authors and Affiliations

  1. Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Kate Poropatich

  2. Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Joel Fontanarosa & Sandeep Samant

  3. Department of Medicine-Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 300 E Superior Street-Tarry 4-726, Chicago, IL, 60611, USA

    Jeffrey A. Sosman & Bin Zhang

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  1. Kate Poropatich
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  2. Joel Fontanarosa
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  4. Jeffrey A. Sosman
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Correspondence to Bin Zhang.

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Conflict of interest

Jeffery Sosman has received consulting fees or honorarium from Genentech, BMS, and Merck. All other authors declare no conflict of interest.

Funding

The research was in part supported by National Institutes of Health grant CA149669, a Cancer Center Support Grant (NCI CA060553), and the Walter S. and Lucienne Driskill Immunotherapy Research fund.

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Poropatich, K., Fontanarosa, J., Samant, S. et al. Cancer Immunotherapies: Are They as Effective in the Elderly?. Drugs Aging 34, 567–581 (2017). https://doi.org/10.1007/s40266-017-0479-1

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