Evaluating the potential of immunotherapy and chemoimmunotherapy in the treatment of elderly non-small cell lung cancer patients: A real-world study

Clinical Characteristics of Toxicities of Immune Checkpoint Inhibitors and Their Impact on Efficacy in Solid Cancers: An Analysis of Real-World Data in Moroccan Patients

PURPOSE

Patients receiving immune checkpoint inhibitors (ICIs) may induce immune-related adverse events (irAEs). This study aimed to evaluate the toxicity induced by ICIs and explore the correlation between efficacy and toxicity in a Moroccan population.

METHODS

We conducted a prospective study of patients with solid tumors who received pembrolizumab or atezolizumab at the National Institute of Oncology, Rabat from July 2018 to December 2023. We identified irAEs according to ASCO 2021 guidelines and graded them according to the Common Terminology Criteria for Adverse Events Version 4.0. Efficacy with respect to progression-free survival (PFS) and overall survival (OS) was determined. A Cox regression model was used to determine the association between irAEs and survival.

RESULTS

Eighty-six patients with solid tumors who received ICIs were included. The primary tumor types were lung (40.7%), skin (29.1%), and GI cancer (14%). The ICIs most commonly used included pembrolizumab (67.4%) and atezolizumab (32.6%). ICIs were used as monotherapy (77.9%) or in combination (22.1%). A total of 58 (67.4%) patients presented any kind of irAEs. The most common toxicities in both the monotherapy and combination groups were GI, with rates of 25.3% and 31.5%, respectively. Patients with irAEs showed significantly longer median PFS compared with those without irAEs (9 v 3.6 months; hazard ratio [HR], 0.5 [95% CI, 0.32 to 0.99]; P = .04). The median OS was longer in patients with irAEs than in those without irAEs but was not statistically significant (19 v 10.3 months; HR, 0.8 [95% CI, 0.39 to 1.7]; P = .5).

CONCLUSION

Our results indicated that ICIs have the potential to induce irAEs in patients with solid tumors. These adverse effects were commonly GI. The development of irAEs was associated with improved effectiveness of ICI treatment across different malignancies.

The Impact of Immune-Related Adverse Event Severity on Prognosis in Elderly Patients With Nonsmall-Cell Lung Cancer in First-Line Immune Checkpoint Inhibitor Treatment

BACKGROUND

Recently, the treatment needs of elderly lung cancer patients have become comparable with those of younger patients. This study evaluated the efficacy and safety of first-line immune checkpoint inhibitors (ICI) in elderly patients with nonsmall-cell lung cancer (NSCLC), stratified by immune-related adverse events (irAEs) severity, and identified key prognostic factors.

METHODS

This retrospective study targeted patients with advanced or recurrent NSCLC who received ICI therapy as first-line treatment between April 2017 and March 2023.

RESULT

Of the 138 patients enrolled in this study, 81 and 57 patients were classified into the elderly (aged 70 and above) and nonelderly (under 70 years old) groups, respectively. Severe irAEs were significantly associated with shorter overall survival (OS) in the elderly group (severe irAEs vs. others, 9.9 vs. 24.7 months; p = 0.043) and favorable OS in nonelderly group (severe irAEs vs. others, NR [not reached] vs. 21.0 months, p = 0.026). The OS of patients with severe irAEs was significantly worse in the elderly group than in the nonelderly group (elderly group vs. nonelderly group, 9.9 vs. NR months, p = 0.001). In the multivariate analysis, mild irAEs were associated with a favorable prognosis in elderly patients (hazard ratio, 0.446; p = 0.032).

CONCLUSION

Severe irAEs demonstrated different outcomes in elderly and nonelderly patients. Contrastingly, mild irAEs were associated with a favorable prognosis in elderly patients, emphasizing the need for appropriate patient selection, early intervention for irAEs and new tools to accurately predict irAE severity in elderly patients.

Clinical benefit of anti-PD-1/PD-L1 plus chemotherapy in first-line treatment for patients over the age of 65 or 75 with metastatic non-small cell lung cancer (NSCLC)

Anti-PD-1/PD-L1 plus chemotherapy (CT) is considered the standard of care in first line treatment of metastatic NSCLC. However, the clinical benefit of this combination in older patients is controversial. We performed a meta-analysis of phase III randomized trials that compared PD-1/PD-L1 inhibitor plus CT with CT alone in first line of treatment for older patients with advanced NSCLC. Subgroups of patients over 65 and over 75 were analyzed. The outcomes included overall survival (OS) and progression-free survival (PFS). A fixedeffect model was used. We analyzed ten trials with an anti-PD-1 (camrelizumab, cemiplimab, nivolumab, pembrolizumab, tislelizumab or toripalimab) and six trials with an anti-PD-L1 (atezolizumab, durvalumab or sugemalimab), including 3666 patients over the age of 65 (41%) and 282 patients over the age of 75 (<10%). For patients over 65 years of age, anti-PD- 1/PD-L1 + CT was significantly associated (hazard ratio [95% confidence interval]) with prolonged OS (0.79 [0.72-0.86]; p < 0.00001) and P FS (0.63 [0.58-0.68]; p < 0.00001) compared to CT alone. Survival benefits occurred in both anti-PD-1 and anti-PD-L1 trials. For patients over 75 years of age, OS benefit was not statistically significant (0.88 [0.67-1.16]; p = 0.37). For patients over the age of 65 with untreated NSCLC, the anti-PD-1/PD-L1 combination with CT, compared with CT alone, is associated with significantly improved OS and PFS. Due to the low number of patients, it is difficult to conclude for those over 75.

Efficacy of adjuvant immune checkpoint inhibitors pembrolizumab or nivolumab in melanoma patients ≥ 75 years: results of a real-world cohort including 456 patients

BACKGROUND

Immune checkpoint inhibitors (ICI) applied in patients with melanoma in an adjuvant setting have proven safety and efficacy in several studies, but data on elderly patients aged 75 years or more is scarce. Aim of this study was to investigate efficacy and safety of adjuvant ICI in patients aged ≥ 75 years compared to patients < 75 years in a real-world setting.

METHODS

We retrospectively analyzed clinical data, including occurrence of immune-related adverse events (irAE) and outcome of 456 patients that had been treated with adjuvant ICI between January 1st, 2018 and December 20th, 2022. We then compared patients aged ≥ 75 years (n = 117) to patients < 75 years (n = 339) in terms of safety and disease-free survival (DFS).

RESULTS AND CONCLUSION

ICI were well tolerated in both groups, with no significant difference observed in the overall occurrence of irAE. However, within the elderly subgroup, there was a significantly higher proportion of skin or nephrological toxicity and colitis/diarrhea compared to the other group. In terms of efficacy, a significantly shorter DFS in patients aged ≥ 75 years was observed. Adjuvant ICI in patients ≥ 75 years was less effective and furthermore associated with an increased risk for skin, renal or bowel toxicity. Therefore, in elderly patients, adjuvant ICI should be used with precaution.