Efficacy and Adverse Events of Immunotherapy with Checkpoint Inhibitors in Older Patients with Cancer

Holstein, Yara van; Kapiteijn, Ellen; Bastiaannet, E.; Bos, Frederiek van den; Portielje, Johanneke E.A.; Glas, Nienke A. de

doi:10.1007/s40266-019-00697-2

Cited by 84 publications

(73 citation statements)

References 61 publications

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“…The progression of a correct immune response is characterized by some immunological checkpoints that prevent unwanted and harmful self-directed activities that lead to autoimmunity [ 76 , 77 ]. Therapies developed to overcome these mechanisms by blocking the inhibitory checkpoints allow generating antitumor activity alone or in synergism with other therapies.…”

Section: Immunotherapy For Metastatic Melanomamentioning

confidence: 99%

Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions

Ralli

Botticelli

Visconti

et al. 2020

Journal of Immunology Research

166

138

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Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.

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Section: Immunotherapy For Metastatic Melanomamentioning

confidence: 99%

Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions

Ralli

Botticelli

Visconti

et al. 2020

Journal of Immunology Research

166

138

View full text Add to dashboard Cite

show abstract

“…To our knowledge, there are no studies on how to treat irAEs specifically in older patients, but dose adjustment is not recommended, similar to any other situation with anti PDL-1 therapy. 34,86 Since older patients who have cancer are often taking additional medications for other comorbidities, it is important to state that ICI treatment is not metabolised by cytochrome P450 enzymes, therefore enzymatic competition is not expected. Patients treated with anticoagulant or antiplatelet therapy must be carefully monitored in cases where colitis symptoms are identified, given the risk of gastrointestinal hemorrhage.…”

Section: Immunotherapy In High Risk Populations Patients With Auto Immentioning

confidence: 99%

“…41 A geriatric assessment could help identify older patients who will benefit from ICI treatment. 86 Since half of all malignancies are diagnosed in patients older that 65 years old, dedicated studies are necessary for the proper and safe use of ICI treatment in the older patient population. 8,41 Since there are no differences in treatment efficacy compared to younger patients, and toxicity levels are acceptable, there are no restrictions to using ICI treatment in older patients, but close monitoring is important.…”

Section: Immunotherapy In High Risk Populations Patients With Auto Immentioning

confidence: 99%

<p>Management of Immune Checkpoint Inhibitor Toxicities</p>

Durrechou¹,

Domblides²,

Sionneau³

et al. 2020

CMAR

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Immune checkpoint inhibitors (ICIs) have radically changed the clinical outcome of several cancers with durable responses. CTLA-4 (cytotoxic T lymphocyte antigen-4), PD-1 (programmed cell death protein 1) or PDL-1 (programmed cell death ligand protein 1) represent ICIs that can be used as monotherapy or in combination with other agents. The toxicity p\rofiles of ICIs differ from the side effects of cytotoxic agents and come with new toxicities like immune-related adverse events. Typically, these toxicities occur in all organs. However, the main organs affected are the skin, digestive, hepatic, lungs, rheumatologic, and endocrine. Most of the immune toxicity that occurs is low grade but some more severe toxicities can occur that require a rapid diagnosis and appropriate treatment. The recognition of symptoms by physicians and patient is necessary to resolve them rapidly and adapt treatment to allow the toxicity to resolve.

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“…There is a growing concern that altered immunological homeostasis will negatively impact the efficacy and safety of immunotherapy treatments in aged and elderly individuals. 92,93 This belief stems from the well-established immunological decline documented in aged mice and humans. 24 To this end, we sought to determine whether aging adversely impacts the efficacy of various classes of immunotherapy by reviewing studies conducted in aged murine models and clinical trials enrolling aged study participants.…”

Section: Efficacymentioning

confidence: 99%

Aging and immunotherapies: New horizons for the golden ages

Hamilton

Henry

2020

Aging and Cancer

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The life expectancy of the world's elderly population (65 and older) continues to reach new milestones with older individuals currently comprising greater than 8.5% (617 million) of the world's population. This percentage is predicted to approach 20% of the world's population by 2050 (representing 1.6 billion people). Despite this amazing feat, many healthcare systems are not equipped to handle the multitude of diseases that commonly manifest with age, including most types of cancers. As the world's aging population grows, cancer treatments continue to evolve. Immunotherapies are a new drug class that has revolutionized our ability to treat previously intractable cancers; however, their efficacy in patients with compromised immune systems remains unclear. In this review, we will discuss how aging-associated losses in immune homeostasis impact the efficacy and safety of immunotherapy treatment in preclinical models of aging. We will also discuss how these findings translate to elderly patients receiving immunotherapy treatment for refractory and relapsed cancers, as well as, strategies that could be explored to improve the efficacy of immunotherapies in aged patients.

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Efficacy and Adverse Events of Immunotherapy with Checkpoint Inhibitors in Older Patients with Cancer

Cited by 84 publications

References 61 publications

Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions

Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions

<p>Management of Immune Checkpoint Inhibitor Toxicities</p>

Aging and immunotherapies: New horizons for the golden ages

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