Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer

Johns, Andrew; Yang, Min; Wei, Lai; Grogan, Madison; Spakowicz, Daniel; Patel, Sandipkumar; Li, Mingjia; Husain, Marium; Kendra, Kari; Rosko, Ashley; Andersen, Barbara L.; Carbone, David P.; Owen, Dwight H.; Presley, Carolyn J.

doi:10.1093/oncolo/oyad097

Cited by 4 publications

(1 citation statement)

References 45 publications

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“…In this study, patients aged ≥75 years were defined as elderly according to the guidelines of the Japanese Lung Cancer Association; however, a recent expert panel evaluating immunotherapy in the older population mentioned that elderly patients should be considered only as a surrogate for clinical factors of frailty [ 20 ]. Cognitive function and life-space mobility, but not age, have been reported as risk factors for irAEs in older adults [ 30 ]. As this study was a retrospective analysis, we could not examine other surrogate markers in elderly patients, including comorbidities.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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Safety of immune checkpoint inhibitors in patients aged over 80 years: a retrospective cohort study

Ikoma,

Matsumoto,

Boku

et al. 2024

Cancer Immunol Immunother

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Background Immuno-oncology (IO) drugs are essential for treating various cancer types; however, safety concerns persist in older patients. Although the incidence of immune-related adverse events (irAEs) is similar among age groups, higher rates of hospitalization or discontinuation of IO therapy have been reported in older patients. Limited research exists on IO drug safety and risk factors in older adults. Our investigation aimed to assess the incidence of irAEs and identify the potential risk factors associated with their development. Methods This retrospective analysis reviewed the clinical data extracted from the medical records of patients aged > 80 years who underwent IO treatment at our institution. Univariate and multivariate analyses were performed to assess the incidence of irAEs. Results Our study included 181 patients (median age: 82 years, range: 80–94), mostly men (73%), with a performance status of 0–1 in 87% of the cases; 64% received IO monotherapy. irAEs occurred in 35% of patients, contributing to IO therapy discontinuation in 19%. Our analysis highlighted increased body mass index, eosinophil counts, and albumin levels in patients with irAEs. Eosinophil count emerged as a significant risk factor for any grade irAEs, particularly Grade 3 or higher, with a cutoff of 118 (/μL). The group with eosinophil counts > 118 had a higher frequency of irAEs, and Grade 3 or higher events than the group with counts ≤ 118. Conclusion IO therapy is a safe treatment option for patients > 80 years old. Furthermore, patients with elevated eosinophil counts at treatment initiation should be cautiously managed.

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Geriatric Assessment in the Era of Targeted and Immunotherapy

Faour,

Guo,

Puts

2024

Drugs Aging

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Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer

Cited by 4 publications

References 45 publications

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

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

Safety of immune checkpoint inhibitors in patients aged over 80 years: a retrospective cohort study

Geriatric Assessment in the Era of Targeted and Immunotherapy

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