Immunotherapy in the Elderly.

Area of Science:

• Oncology
• Immunology
• Geriatrics

Background:

• Immunotherapy is increasingly used for genitourinary (GU) malignancies, including prostate, urothelial (UC), and renal cell carcinoma (RCC).
• Limited data exist on the efficacy and safety of these treatments specifically in elderly patient populations.

Purpose of the Study:

• To systematically review and evaluate the evidence on the efficacy and safety of immunotherapy in older patients with prostate cancer, UC, or RCC.

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed/Medline, Embase, Web of Knowledge, Cochrane Library) up to October 2017.
• A narrative review of 21 selected reports was performed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Main Results:

• Studies in prostate cancer indicated survival benefits with sipuleucel-T in older patients.
• For metastatic UC, checkpoint inhibitors showed similar response rates across different age groups (e.g., <65 vs. ≥65 years, <80 vs. ≥80 years).
• In metastatic RCC, while cytokine therapy showed no age-related efficacy differences, nivolumab benefit was more pronounced in patients aged 65-74 years compared to those ≥75 years. Toxicity data stratified by age was minimal.

Conclusions:

• Current immunotherapy treatments for GU malignancies appear to benefit patients irrespective of age.
• Detailed reporting of outcomes and toxicities stratified by age in clinical trials is crucial for understanding treatment generalizability in elderly populations.