Immunotherapy phase I trials in patients Older than 70 years with advanced solid tumours. (May 2018)

• Record Type: Journal Article
• Authors: Herin, H.; Aspeslagh, S.; Castanon, E.; Dyevre, V.; Marabelle, A.; Varga, A.; Postel Vinay, S.; Michot, J.M.; Ribrag, V.; Gazzah, A.; Bahleda, R.; Mir, O.; Massard, C.; Hollebecque, A.; Soria, J.C.; Baldini, C.
• Is Part Of: European journal of cancer. Volume 95(2018)
• Page Start: 68
• Page End: 74
• Publication Date: 2018-05
• Subjects: Phase I trials -- Immunotherapy -- Older patients; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2018.03.002
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: The development of immune checkpoint blocker development brings new hope in older patients (OPs) because of clinical efficacy and low toxicity. Clinical indications are rising steadily, but very few data are available in the geriatric population where comorbidities, reduced functional reserve and immunosenescence may affect efficacy and tolerance. Methods: All cases of patients enrolled in immunotherapy phase I trials between January 2012 and December 2016 in the Drug Development Department (DITEP) at Gustave Roussy were retrospectively reviewed. Case–control analysis was performed in OPs (patients ≥ 70 years) matched to younger patients (YPs) (patients < 70 years) by trial and treatment dose. We compared cumulative incidence, grade and type of immune-related adverse events (IrAEs) and survival outcomes. Results: Among the 46 OPs and the 174 YPs enrolled in 14 phase I/II trials, 10 (22%) and 23 (13%) patients experienced grade III–IV IrAEs. Cumulative incidence of grade I–II IrAEs was significantly higher in OPs than YPs (p < 0.05). No significant difference was observed between the two groups for grade III–IV IrAEs (p = 0.50). Older age was not associated with lower dose intensity of treatment (p = 0.14). No significant difference was observed between OPs and YPs in median progression-free survival (hazards ratio 1.41, 95% confidence interval [CI] [0.94–2.11] p = 0.09) or median overall survival (HR 0.92, 95% CI [0.61–1.39] p = 0.77). Conclusion: Immune checkpoint blockade appears to be an acceptable treatment option for OPs in the setting of phase I trials. Highlights: A decline of both innate and adaptive immunity is observed with increasing age which is called immunosenescence. Toxicity of immunotherapy in older patients is manageable, but there is an increased proportion of grade I–II adverse events. Adverse events occurred sooner in older patients than in younger patients (16 d versus 36 d). Efficacy data were comparable between older and younger patients.