1847P - Safety and efficacy of immune checkpoint inhibitors in patients over 85 years: ICIPO85 study

Background

Multiple studies show the safety and benefit of immune checkpoint inhibitors (ICI) to treat solid tumors in geriatric population. However, most of the patients included were under 80 years. Clinical data are lacking in patients over 85 years old. The aim of this study is to evaluate the outcome of ICI in this specific population.

Methods

A multicenter, retrospective cohort study included patients over 85 years at ICI initiation, for localized or metastatic solid cancers between 2015 and 2023. The primary outcome was safety. Secondary outcomes were overall survival (OS) for all patients, OS according to primary cancer localization and identification of favorable prognosis factors.

Results

We analyzed 114 patients, median age was 88 (85 to 101 years). Age-adjusted Charlson comorbidity index had a median of 12 (from 2-19) and ECOG at first injection was 0 or 1 for 70% of all patients. Among the full cohort, 57 patients (50%) had skin cancer (of which 45 were melanomas (40%)), 31 (27%) had lung cancer and 38 (33%) had other primary localizations. ICI was used at a metastatic stage in 98 patients (85%) and was the first line of treatment for 76 patients (66%). Immune-related adverse events (irAEs) occurred 45 times in 33 patients (29%), mainly endocrine and cutaneous rash. Thirteen irAEs were grade 3 (28%) and none were grade ≥ 4 based on CTCAE (v5.0). Median OS for all patients was 12.1 months (95% CI 8.9-18.2) and according to primary localization was 17.8 months (95% CI 9.2-21.1) for skin cancer and 3.9 months (95% CI 1.6-12.1) for lung cancer. Median OS was significantly longer when patients had less than 3 daily medications (HR 1.82, 95% CI 1.06-3.14, p=0.03) and statistically shorter when patients had lung cancer (HR 2.72, 95% CI 1.45-5.11, p=0.002).

Conclusions

ICI presented a favorable profile of safety and benefit in this very elderly population. Age shouldn’t be a limitation to initiate ICI.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

S. Dalle: Financial Interests, Institutional, Advisory Board: MSD, BMS; Financial Interests, Personal, Stocks/Shares, Spouse Sanofi employee and stock owner: Sanofi; Financial Interests, Institutional, Research Grant: BMS, MSD, AstraZeneca. P. Corbaux: Financial Interests, Personal, Invited Speaker: GSK; Financial Interests, Institutional, Local PI: Sensorion, Roche, Novartis, MSD. T. Reverdy: Financial Interests, Speaker, Consultant, Advisor: Lilly; Financial Interests, Advisory Board: Novartis, AstraZeneca. All other authors have declared no conflicts of interest.