Real‐world data on the efficacy and safety of immune‐checkpoint inhibitors in elderly patients with non‐small cell lung cancer

Morinaga, Daisuke; Asahina, Hajime; Ito, Shotaro; Honjo, Osamu; Tanaka, Hisashi; Honda, Ryoichi; Yokouchi, Hiroshi; Nakamura, Keiichi; Takamura, Kei; Hommura, Fumihiro; Kawai, Yasutaka; Ito, Kenichiro; Sukoh, Noriaki; Yokoo, Keiki; Morita, Ryo; Harada, Toshiyuki; Takashina, Taichi; Goda, Tomohiro; Dosaka‐Akita, Hirotoshi; Isobe, Hiroshi

doi:10.1002/cam4.5889

Cited by 10 publications

(6 citation statements)

References 44 publications

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“…The current lung cancer treatment strategy recommends testing for gene variants and programmed cell death ligand 1 immunohistochemistry (PD‐L1 IHC) for patients with metastatic non‐small cell lung cancer. 7 There are several reports that molecularly targeted agents and immunotherapy could be safely administered to elderly lung cancer patients, 17 , 18 , 19 emphasizing the crucial importance of making a diagnosis by FB, even for elderly patients, in order to receive appropriate treatment.…”

Section: Discussionmentioning

confidence: 99%

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

Saito,

Oi,

Ito

et al. 2024

Thoracic Cancer

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BackgroundThere have been several reports demonstrating the safety of flexible bronchoscopy (FB) in the elderly, but none have focused specifically on lung cancer, which is a frequent biopsy procedure.MethodsIn this study, we retrospectively evaluated the safety of FB and subsequent treatment in elderly patients with suspected primary lung cancer. Elderly patients were defined as 75 years of age or older.ResultsA total of 141 patients, 77 in the elderly group and 64 in the nonelderly group, were reviewed. The median age of the elderly group was 80 years. Transbronchial lung biopsy was performed in more than 80% of all patients. Primary lung cancer was diagnosed in 42 (54.4%) of the elderly group and 35 (54.7%) of the nonelderly group (p = 0.38). Approximately 70% of the elderly patients with a confirmed diagnosis were treated, while more than half of the undiagnosed elderly patients had best supportive care. Complications such as bleeding, pneumothorax, fever, and pneumonia were similar in the elderly and nonelderly groups.ConclusionsThis study suggests that flexible bronchoscopy can be performed as safely in the elderly as in the nonelderly. Furthermore, even elderly patients may have a greater chance of receiving treatment when a definitive diagnosis is achieved.

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Section: Discussionmentioning

confidence: 99%

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

Saito,

Oi,

Ito

et al. 2024

Thoracic Cancer

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“…However, integrated analyses of previous clinical trials have demonstrated a significantly prolonged prognosis in elderly patients with untreated NSCLC receiving ICI therapy compared to those receiving chemotherapy alone, mirroring the outcomes seen in younger patients [ 5 ]. Moreover, real-world evidence suggests a comparable treatment efficacy between younger and older populations [ 6 , 7 , 19 ]. Our results also showed that chronological age did not affect PFS after ICI treatment, which is consistent with these results.…”

Section: Discussionmentioning

confidence: 99%

“…Immune checkpoint inhibitors (ICIs) have emerged as indispensable frontline therapies to manage advanced or recurrent NSCLCs without druggable mutations [ 4 ]. However, considering the age-associated immunosenescence, confirming ICI efficacy in elderly patients is necessary, and several studies have provided valuable insights [ 5 , 6 , 7 , 8 ]. Moreover, ICIs cause a unique array of adverse effects, termed immune-related adverse events (irAEs), wherein reinvigorated immune responses may inadvertently target healthy organs [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…An integrated analysis encompassing three clinical trials that evaluated pembrolizumab demonstrated that irAE incidence in elderly patients with NSCLC was comparable to that in younger cohorts [ 5 ]. Morinaga et al conducted a real-world clinical study and observed that the irAE profile remained consistent across age groups [ 7 ]. However, Tsukita et al reported that combining ICI with chemotherapy in patients aged ≥75 years did not confer survival benefits and was associated with an increased incidence of grade ≥3 irAEs compared to ICI monotherapy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Real-World Prevalence and Tolerability of Immune-Related Adverse Events in Older Adults with Non-Small Cell Lung Cancer: A Multi-Institutional Retrospective Study

Matsukane,

Oyama,

Tatsuta

et al. 2024

Cancers

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With cancer diagnosis occurring at older ages, the use of immune checkpoint inhibitors (ICIs) has extended to older adults. However, the safety of immune-related adverse events (irAEs) in this population remains unclear and relies on data extrapolated from younger adults. This multicenter retrospective study aimed to examine irAE prevalence and tolerability in older adults. We included 436 patients with non-small lung cancer undergoing ICI therapy and dichotomized them into two age groups (< or ≥75 years). Incidence of any irAE grade, grade ≥3 irAEs, and steroid usage after irAE occurrence was similar between younger (n = 332) and older groups (n = 104). While the younger patients with irAEs showed prolonged overall survival in the 12-month landmark Kaplan–Meier analysis (Hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.38–0.89, p = 0.013), the older cohort did not (HR 0.80, 95% CI 0.36–1.78, p = 0.588). Although no differences were observed with ICI continuation or re-challenge after irAE onset, the elderly cohort had double the irAE cases that required a transition to best supportive care (BSC) (11.3% vs. 22.4%, p = 0.026). In conclusion, although irAE prevalence remains consistent regardless of age, the increased conversion to BSC post-irAE onset in older adults suggests diminished tolerability and the potential absence of favorable prognosis associated with irAEs in this population.

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“…Pembrolizumab monotherapy was also acceptably safe, although treatment-related AEs of grade ≥3 were more common in patients aged ≥75 years than in those aged <75 years (16.9% vs. 24.2%). In addition, several retrospective studies have demonstrated the efficacy and safety of ICI monotherapy in patients with NSCLC aged ≥75 years ( 20 , 37 - 39 ). In our prospective observational study of 31 patients with NSCLC aged ≥75 years, pembrolizumab monotherapy elicited a good therapeutic response, with a median PFS of 5.3 months, a median OS of 11.6 months, and an acceptable safety profile ( 27 ).…”

Section: Elderly Patientsmentioning

confidence: 99%

The landscape of immune therapy in vulnerable patients with advanced non-small cell lung cancer: a narrative review

Morimoto,

Yamada,

Takayama

2023

Transl Lung Cancer Res

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Background and Objective The clinical development of immune checkpoint inhibitors (ICIs) has led to substantial advances in the treatment of lung cancer. In particular, the contribution of ICIs to the long-term survival of certain patients with non-small cell lung cancer (NSCLC) has been reported. With the accumulated experience in the use of ICIs, numerous studies have documented the efficacy and safety of ICIs in patients with diverse backgrounds, including those with problematic indications for drug therapy. In the current review, we summarize the most recent literature-based findings on ICI administration in vulnerable patients with NSCLC and provide an overview of the current status and prospects of ICIs. Methods Herein, we defined vulnerable as the group of patients with NSCLC and performance status (PS) ≥2 (poor PS), advanced age (≥75 years), or cancer cachexia. We conducted a narrative review of the literature on the efficacy and safety of ICIs in vulnerable patients with advanced NSCLC. Key Content and Findings Among the vulnerable patient group, poor PS was a strong, poor prognostic factor, even in patients undergoing ICI therapy. ICI therapy in older patients can be effective, although adverse events (AEs) should be carefully monitored. The efficacy of ICI therapy in patients with cancer cachexia is poor, with further therapeutic development warranted. Conclusions Although prior studies have evaluated lung cancer pharmacotherapy in various vulnerable populations, clinical studies on the application of ICIs in patients with vulnerable NSCLC are lacking in both number and quality. Further development of these therapeutic agents, with the emergence of additional evidence regarding their appropriate use in this population, is expected.

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Real‐world data on the efficacy and safety of immune‐checkpoint inhibitors in elderly patients with non‐small cell lung cancer

Cited by 10 publications

References 44 publications

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

Real-World Prevalence and Tolerability of Immune-Related Adverse Events in Older Adults with Non-Small Cell Lung Cancer: A Multi-Institutional Retrospective Study

The landscape of immune therapy in vulnerable patients with advanced non-small cell lung cancer: a narrative review

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