2333 - Efficacy and safety of immune checkpoint inhibitors (ICIs) for treatment of advanced solid tumours in octogenarian patients

Background

The emergence of ICIs has modified the treatment of many types of cancers. However, efficacy and safety data of such agents (anti PD-1/anti PD-L1) are cruelly missing in elderly patients ⩾ 80 year-old.

Methods

A retrospective monocentric study was conducted between April 2015 and April 2019 in all ⩾ 80 year-old ICIs-treated patients, as a part of a clinical trial or standard of care. Patients/disease characteristics were collected using electronic medical records. Clinical response was assessed according to iRECIST criteria; survival was estimated according to Kaplan-Meier method and toxicity was assessed according to CTCAE v 4.0.

Results

Of the 415 patients who received an ICI, 42 (10.1%) were aged ⩾ 80 years (median: 84; range: 80-93). The most represented tumour types were NSCLC (45.2%), renal cell carcinoma (30.9%) and bladder carcinoma (16.7%). 92.9% were stage IV. ICIs were given as first-line therapy in 7 patients (16.7%) and as second-line or beyond in 35 patients (83.3%). 29 patients had nivolumab, 10 patients had pembrolizumab and 3 had atezolizumab. ICIs were given mostly as monotherapy (97.6%). A median of 7.5 doses were administered (range: 1-37). Of the 42 patients, 40.5% were PS ⩾ 2 and 88.1% had impaired G8 score. Mean Charlson Index was 3 (range: 0-6), polypharmacy was present in 26 cases and 35.7% had an albumin level < 35g/L (Mean 33.3; range: 22-44). The Objective Response Rate was 11.9% and the Disease Control Rate was 31%. The median progression-free survival was 5 months [95% CI: 2-10] and the median overall survival was 9 months [95% CI: 6-21]. 26 patients died during the treatment, 16 are still alive; 1 with complete response, 8 stable disease and 7 progressed. All-grade adverse events occurred in 100% of patients, mostly Grade 1 fatigue and anorexia. Immune-related adverse events (IrAEs) occurred in 76.2%, most of them were common and mild; dyspnea, thyroïditis, rash and diarrhea. 9 severe IrAEs occurred; colitis, pneumonitis, rash and arthralgia. Reasons for off therapy included progressive disease (n = 23; 54.8%), adverse effects (n = 5; 11.9%) and death (n = 6; 14.3%).

Conclusions

ICIs appear to be an acceptable treatment option for octogenarian patients, with manageable toxicity.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Mebarki Soraya.

Funding

Has not received any funding.

Disclosure

E. Fabre: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): BMS; Honoraria (self): Merck. S. Oudard: Research grant / Funding (self): Boehringer; Honoraria (self): Ipsen; Honoraria (self): Bayer; Honoraria (self), Travel / Accommodation / Expenses: Pfize; Honoraria (self), Travel / Accommodation / Expenses: MSD; Honoraria (self), Travel / Accommodation / Expenses: Astellas; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Janssen; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: BMS; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Sanofi. E. Paillaud: Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self): Servier; Honoraria (self), Travel / Accommodation / Expenses: Roche. All other authors have declared no conflicts of interest.