Melanoma or advanced NSCLC: immune checkpoint inhibitors for octogenarians?

Conclusions

• A retrospective cohort indicates that patients aged ≥80 years have reasonably good survival and safety outcomes with immune checkpoint inhibitor (ICI) inhibitors for melanoma or non-small cell lung cancer (non-small cell lung cancer, NSCLC) in advanced stages, but 18.5% discontinue treatment due to grade 3–4 toxicity.

Why it matters

• The first real-world study on the safety and efficacy of ICI specifically in patients aged ≥80 years.
• The study authors favorably recommend treating octogenarians with ICI, as long as a geriatric evaluation is conducted before treatment and during treatment.

Study design

• Retrospective cohort of 82 patients aged ≥80 years with advanced melanoma or advanced NSCLC treated at 14 institutions in Brittany, France (period 2014–2017).
• Primary outcome:  progression-free survival (PFS).
• Secondary outcomes: overall survival (OS), safety profile according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, including immune-related adverse events (IRAEs).
• Funding: Not disclosed.

Main results

• 45 patients had melanoma; 36 NSCLC.
• Median follow-up was 12.6 months.
• The most common ICIs were nivolumab and pembrolizumab.
• Efficacy in NSCLC
  • PFS median of 2.3 months (95% CI, 1.8–6.1 months).
  • Median OS of 8.8 months (95% CI, 5.5–18.1 months).
• Efficacy in melanoma
  • Median PFS of 10.2 months (95% CI, 4.5–20.0 months).
  • Median OS  of 24.5 months (95% CI, 14.1 months–not reached).
• 96.2% of deaths were caused by disease progression.
• A higher body mass index (BMI) (HR=0.85; 95% CI, 0.74–0.98) and higher albumin levels (HR=0.87; 95% CI, 0.78–0.96) were independently associated with better OS.
• 42% of patients developed IRAE of any grade.
• The most common IRAEs of any grade were:
  • skin toxicity (11.1%);
  • diarrhea (9.9%);
  • fatigue (9.9%);
  • pneumonia (6.2%);
  • thyroid dysfunction (4.9%).
• 18.5% of patients developed grade 3–4 IRAE leading to treatment discontinuation: 16.7% in the NSCLC group and 20% in the melanoma group.
• One patient in the melanoma group died due to ICI-induced lung toxicity.

• PFS median of 2.3 months (95% CI, 1.8–6.1 months).
• Median OS of 8.8 months (95% CI, 5.5–18.1 months).

• Median PFS of 10.2 months (95% CI, 4.5–20.0 months).
• Median OS  of 24.5 months (95% CI, 14.1 months–not reached).

• skin toxicity (11.1%);
• diarrhea (9.9%);
• fatigue (9.9%);
• pneumonia (6.2%);
• thyroid dysfunction (4.9%).

Limits

• Observational, retrospective, non-interventional design.
• Small number of patients.

Access to the site is restricted and reserved for healthcare professionals

You have reached the maximum number of visits