Immunotherapy Appears Safe, Effective in Elderly With Lung Cancer

By Reuters Staff

October 30, 2019

NEW YORK (Reuters Health) - Immunotherapy appears to be safe and effective for treating non-small-cell lung cancer (NSCLC) in older people, researchers from Italy report.

Several trials have demonstrated the efficacy of immunotherapy in NSCLC, but most have excluded elderly patients from enrollment.

To investigate, Dr. Giulia Galli and colleagues from Fondazione IRCCS Istituto Nazionale dei Tumori, in Milan, Italy, examined outcomes of immunotherapy retrospectively in 290 patients with advanced NSCLC. The patients were treated between 2013 and 2019, 180 were under 70, 94 were 70-79 years old and 16 were over 80.

More than a third of patients (37.2%) were fully active with no restrictions (ECOG performance status (PS) 0), 50.7% had some restrictions (PS 1) and 12.1% were ambulatory and capable of self-care but not able to work (PS 2).

Immunotherapy included an anti-PD1 in 205 patients, an anti-PDL1 in 77 patients and an anti-CTLA4 or combination immunotherapy in eight patients.

Immunotherapy was generally well tolerated, with 27.6% of patients developing toxicities graded 2 or higher, the researchers report in Lung Cancer, online September 10.

Response rates to immunotherapy were similar in the three age groups: 21.5% for those under 70, 22.3% for septuagenarians and 18.8% for those 80 years and older.

Median progression-free survival (PFS) was 3.0 months, and median overall survival (OS) was 9.93 months, with no significant difference when considering age as a continuous variable.

These outcomes compare with a response rate of 19%, PFS of 2.8 months, and OS of 13.3 months in the recent IMMUNOTARGET registry study of younger patients (median age, 60 years) receiving immune-checkpoint-inhibitor monotherapy for advanced NSCLC.

Higher ECOG performance score, a reflection of greater functional impairment, independently predicted worse progression-free and overall survival.

"This underlines the importance of considering PS, instead of age, when evaluating patients potentially candidate to immunotherapy," the researchers note. "Therefore, a comprehensive evaluation of each cancer patient in advanced age, with the cooperation of a specialist in geriatric medicine, considering the whole medical picture and the global functioning besides the age, should be performed when deciding if a patient is candidate or not to receive active treatment."

"To our opinion, immune checkpoint inhibitors should be considered irrespective of age, provided an optimal PS at baseline," they conclude. "Of note, immunotherapy is often the only therapeutic option applicable to these cases considering the toxicity of chemotherapy."

The study did not have external funding. Several authors report ties to one or more pharmaceutical companies with immunotherapeutic products.

Dr. Galli did not respond to a request for comments.


Lung Cancer 2019.