Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2018 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Impact of age on immune checkpoint blockade tolerability across malignancies: A single institution review.
Immune Checkpoint Inhibitors
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr e15069)
Author(s): Sharon Li, Reetu Mukherji, Sheel A. Patel, Daniel S. Altman, Philip Margiotta, Mario Caldararo, Sean Clark-Garvey, Thomas Holden, Marlana M. Orloff, Ryan Michael Weight, Jennifer Maria Johnson; Jefferson Medcl Coll, Bethesda, MD; Thomas Jefferson University, Philadelphia, PA; Thomas Jefferson University, Philadelphia, PA, US; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Thomas Jefferson University, Department of Medical Oncology, Philadelphia, PA
Background: Immune checkpoint inhibitors have become an integral part of treatment for a variety of malignancies. Given the favorable side effect profile compared to chemotherapy, there is increased interest in using immunotherapy in senior adults. Unfortunately, there is limited and conflicting data exploring the effect of age on checkpoint blockade efficacy and toxicity. We hypothesize that due to increased immune-senescence, older patients will experience less treatment limiting immune toxicity. Methods: A total of 170 patients were identified as receiving anti CTLA-4 or -1/PDL-1 antibodies between 2012 and 2017 at TJUH. Data was analyzed by age cohorts: age < 65, age 65-74, and age > 75. Chi-square analysis was used to compare the various reasons for therapy discontinuation between age groups. Results: 47% of patients were less than age 65; 37% were between age 65 and 75 and 16% of patients were older than age 75. Baseline characteristics between the groups were similar. Median CCI and RMH score was similar across the groups. Interestingly, the rate of immune toxicity requiring therapy discontinuation was higher among patients > 75 compared to < 65 though not significantly different (p = .098). Conversely, rates of disease progression while on immunotherapy were significantly higher in patients < 65 compared to those > 75 years (p = value here 0.037). Conclusions: Despite evidence for immuno-senescence in the elderly, rates of immune toxicity did not differ significantly by age. Further studies are needed to explore interplay of aging, the immune system and check point inhibitors.
|Age Group (yrs)||< 65||65-75||> 75|
|Number of Patients||80 (47.1)||63 (37.0)||27 (15.9)|
|Number of disease sites; mean (median)||2.91 (3)||2.82 (3)||3.08 (3)|
|Charleston Comorbidity Index at Immunotherapy Initiation; |
|0.76 (1)||0.80 (1)||1.41 (1)|
|Royal Marsden Score at Immunotherapy Initiation; |
|7.22 (8)||8.85 (9)||8.22 (9)|
|Doses of Immunotherapy;|
|7.6 (4)||7.6 (4)||8.7 (4.5)|
|Disease progression Rate||32 (40.0)||33 (52.4)||6 (22.2)|
|Immunotoxicity Rate||10 (12.5)||13 (20.6)||7 (25.9)|
|Death Rate||9 (11.3)||6 (9.5)||4 (18.5)|
|Never discontinued treatment||21 (26.3)||6 (9.5)||5 (18.5)|