Toxicity in Older Patients with Cancer Receiving Immunotherapy: An Observational Study.
Estelle Tran Van Hoi1, Stella Trompet2, Yara Van Holstein2
1Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands. e.tran_van_hoi@lumc.nl.
Drugs & Aging
|May 10, 2024
Summary
In older cancer patients receiving immunotherapy, increased frailty correlates with higher risks of toxicity, hospitalization, and treatment discontinuation. Early treatment discontinuation also occurred in patients with lower toxicity grades, indicating reduced tolerance.
Area of Science:
- Geriatric Oncology
- Immunotherapy
- Cancer Treatment
Background:
- Checkpoint inhibitors are effective cancer treatments for older adults.
- Older cancer patients are a heterogeneous group with varying frailty, cognition, and physical status.
Purpose of the Study:
- To investigate the association between clinical frailty and immune-related treatment toxicity.
- To examine the link between frailty and hospitalization and treatment discontinuation due to toxicity in older patients receiving checkpoint inhibitors.
Main Methods:
- Patients aged 70+ from three studies (TENT, IMAGINE, Tolerability and safety of immunotherapy) treated with checkpoint inhibitors were analyzed.
- Clinical frailty was assessed using the Geriatric-8 test and World Health Organization (WHO) performance status.
- Outcomes included grades 3-5 toxicity, hospitalization, and treatment discontinuation related to immune-related adverse events.
Main Results:
- 33% of 99 patients were frail (Geriatric-8 score < 15).
- Frail patients (abnormal Geriatric-8 or higher WHO score) showed trends towards higher odds of toxicity, treatment discontinuation, and hospitalization.
- Early treatment discontinuation was also observed in patients with lower toxicity grades (1-2).
Conclusions:
- Increasing frailty in older cancer patients on immunotherapy is associated with trends of increased toxicity, hospitalization, and treatment discontinuation.
- Larger studies are needed to confirm these exploratory findings.
- Older patients with lower toxicity grades may have reduced tolerance, leading to frequent early treatment discontinuation.
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