Benefit of immunotherapy (IT) in advanced non-small cell lung cancer (NSCLC) in elderly patients (EP)

Fuente, E. Corral de la; García, Ana López; Saavedra, Cristina; Garcia, Maria Eugenia Olmedo; Huertas, R. Martín; Domingo, Juan José Serrano; Artahona, V. Albarrán; Rueda, A. Gómez

doi:10.1093/annonc/mdz063.067

Cited by 11 publications

(7 citation statements)

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“…Safety and efficacy of nivolumab in elderly patients were generally consistent with that of the all-treated population and were similar between the !70-year and !75-year subgroups. Studies of other immunotherapies in elderly patients with NSCLC have shown similar results [38,39], although efficacy appeared to be reduced in elderly versus younger patients in one study [38]. Rates of TRAEs were numerically higher in elderly patients compared with the all-treated population; however, most events were low grade, and no new safety signals were identified.…”

Section: Discussionmentioning

confidence: 84%

CheckMate 171: A phase 2 trial of nivolumab in patients with previously treated advanced squamous non-small cell lung cancer, including ECOG PS 2 and elderly populations

Felip

Ardizzoni

Ciuleanu

et al. 2020

European Journal of Cancer

135

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Background: CheckMate 171 (NCT02409368) is an open-label, multicentre, phase 2 trial of nivolumab in previously treated advanced squamous non-small cell lung cancer (NSCLC), conducted as part of a post-approval commitment to the European Medicines Agency (EMA). We report outcomes from this trial. Methods: Patients with Eastern Cooperative Oncology Group performance status (ECOG PS) 0e2 and disease progression during/after !1 systemic treatment (!1 being platinum-based chemotherapy) for advanced or metastatic disease were treated with nivolumab 3 mg/kg every 2 weeks until progression or unacceptable toxicity. The primary end-point was incidence of grade 3e4 treatment-related select adverse events (AEs). Other end-points included overall survival (OS) and safety. Results: Of 811 patients treated, 103 had ECOG PS 2; 278 were aged !70 years and 125 were !75 years of age. Minimum follow-up was~18 months. Safety was similar across populations; the most frequent grade 3e4 treatment-related select AEs in all treated patients were diarrhoea (1%), increased alanine aminotransferase (ALT, 1%), pneumonitis (0.7%), colitis (0.6%) and increased aspartate aminotransferase (AST, 0.5%). Median OS was similar in all treated patients and those aged !70 and !75: 10.0 months, 10.0 months and 11.2 months, respectively. Median OS was 5.2 months in patients with ECOG PS 2. Conclusion: These results suggest that nivolumab is well tolerated and active in patients with advanced, relapsed squamous NSCLC, including the elderly, with OS outcomes consistent with phase 3 data. In patients with ECOG PS 2, nivolumab had similar tolerability, but outcomes were worse, as expected in this difficult-to-treat, poor prognosis population. Clinical trial registration: NCT02409368.

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Section: Discussionmentioning

confidence: 84%

CheckMate 171: A phase 2 trial of nivolumab in patients with previously treated advanced squamous non-small cell lung cancer, including ECOG PS 2 and elderly populations

Felip

Ardizzoni

Ciuleanu

et al. 2020

European Journal of Cancer

135

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“…239 In the CheckMate 153 phase 3B/4 study assessing nivolumab in previously treated patients with NSCLC, 39% of the 1426 enrolled patients were aged 70 years or older, and 9% had ECOG PS of 2. 240 The incidence of select grade 3-5 tr-AEs (6%-9%) and grade 3 or 4 tr-AEs (12%-14%) was similar across subgroups and the overall population. The median OS was comparable in the overall population (9.1 mo) and patients aged 70 years or older (10.3 mo) but lower (4 mo) for patients with an ECOG PS of 2.…”

Section: The Elderlymentioning

confidence: 87%

“…The median OS was comparable in the overall population (9.1 mo) and patients aged 70 years or older (10.3 mo) but lower (4 mo) for patients with an ECOG PS of 2. 240 Retrospective studies have also shed light on the outcomes of elderly patients when treated with ICI in a real-world setting. One such study of 98 patients (of which, 27 were elderly as defined by age !…”

Section: The Elderlymentioning

confidence: 99%

Immune Checkpoint Inhibitors in Thoracic Malignancies: Review of the Existing Evidence by an IASLC Expert Panel and Recommendations

Remón

Passiglia

Ahn

et al. 2020

Journal of Thoracic Oncology

129

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“…The progression free survival was shorter as well, but at a lesser extend ( p = 0.012). Finally, the toxicity was identical between the 2 sub-groups [ 99 ]. Furthermore, the age comparison results of immunotherapies could be organ and molecule-dependent.…”

Section: Perspective In Immunotherapy Management In Older Patientsmentioning

confidence: 99%

Immunotherapy in older patients with cancer

et al. 2021

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Ageing implicates a remodeling of our immune system, which is a consequence of the physiological senescence of our cells and tissues coupled with environmental factors and chronic antigen exposure. An immune system that senesces includes more differentiated cells with accumulation of highly differentiated CD4 and CD8 T cells. The pool of naive T cells decreases with the exponential thymic involution induced by age. Differentiated T cells have similar, if not higher, functional capacities but scarce studies are looking at the impact of senescence among specific T cells. After a stimulation, other immune cells (monocytes, dendritic cells and NK) are functionally altered during ageing. It is as if the immune system was more efficient at the basal level, but less efficient after a stimulation in the old compared to young people, likely due to less reserve. Concerning the clinical impact, older people are more prone to certain pathogens and their clinical manifestations differ from the younger people. Severe flu and VZV reactivation are more frequent with an altered cellular response to vaccination. Vaccination failure can have detrimental consequences in people presenting frailty criteria. Old people frailty is majored by their comorbidities and diseases like cancer. Thus, chemotherapies are employed with circumspection in older patients. The use of anti-PD-1/PD-L1 immunotherapies is therefore attractive, because of less side effects with a better response compared to chemotherapy. Old persons inclusion is lacking in current studies and clinical trials. Some subgroups or pooled analyses confirm the gain in response without increased toxicities in older patients but their inclusion criteria differ from the real-life practice. Specific studies focusing on this population are needed because of the increasing cancer incidence with age and the overall ageing of the population.

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Benefit of immunotherapy (IT) in advanced non-small cell lung cancer (NSCLC) in elderly patients (EP)

Cited by 11 publications

References 0 publications

CheckMate 171: A phase 2 trial of nivolumab in patients with previously treated advanced squamous non-small cell lung cancer, including ECOG PS 2 and elderly populations

CheckMate 171: A phase 2 trial of nivolumab in patients with previously treated advanced squamous non-small cell lung cancer, including ECOG PS 2 and elderly populations

Immune Checkpoint Inhibitors in Thoracic Malignancies: Review of the Existing Evidence by an IASLC Expert Panel and Recommendations

Immunotherapy in older patients with cancer

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