Effect of age on safety and efficacy of novel cancer drugs investigated in early-phase clinical trials

• Published in: European journal of cancer (1990) 2024-08, Vol.207, p.114181, Article 114181
• Main Authors: Nicolò, Eleonora, Gandini, Sara, Giugliano, Federica, Uliano, Jacopo, D’Ecclesiis, Oriana, Morganti, Stefania, Ferraro, Emanuela, Trapani, Dario, Tarantino, Paolo, Zagami, Paola, Boldrini, Laura, Caramella, Irene, Carnevale Schianca, Ambra, Cristofanilli, Massimo, Locatelli, Marzia Adelia, Esposito, Angela, Belli, Carmen, Minchella, Ida, Criscitiello, Carmen, Marra, Antonio, Curigliano, Giuseppe
• Format: Article
• Language: English
• Subjects: Adverse events; Age; Cancer; Early-phase clinical trial; Elderly; Outcome; Phase I; Safety; Solid tumors; Survival
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2024.114181

Elderly patients are underrepresented in clinical trials, particularly in early-phase studies. Our study assessed the safety and efficacy of novel anti-cancer treatments investigated in early-phase clinical trials, comparing outcomes between younger and elderly patients. This retrospective study analyzed data from patients enrolled in phase I/II trials at our center between January 2014 and April 2021. We evaluated clinicopathologic characteristics, toxicity, and clinical efficacy, categorizing patients into younger (≤ 65 years) and elderly (> 65 years) groups. 419 patients were included with a median age of 56 years. Among these, 107 (26 %) were older than 65 years. Predominant cancers included breast (48 %), lung (10 %), and melanoma (5 %). Patients were treated in 64 trials, predominantly receiving immunotherapy-based (47 %) or targeted therapy-based (45 %) treatment. Elderly presented with poorer ECOG performance status (P = 0.001) and had fewer prior therapy lines (P = 0.01) than younger patients. Grade ≥ 3 adverse events (AEs) were similar across age groups (31 % younger vs 33 % elderly; P = 0.7), including in combination therapy scenarios. However, elderly patients experienced more AEs with antibody-drug conjugates compared to younger counterparts (56 % vs 14 %, P = 0.036) and were more likely to discontinue treatment due to toxicity (15 % vs 7 %; P = 0.011). No significant age-related differences in response rates and survival outcomes were observed across treatment modalities, except for immunotherapy-based regimens for which elderly patients exhibited higher response rates, disease control rates, and prolonged progression-free survival. Our findings suggest that elderly exhibit comparable safety and efficacy outcomes to younger patients in early-phase clinical trials for new cancer drugs. This underscores the importance of including elderly patients in phase I/II trials to ensure the generalizability of study results and mitigate age-related disparities in cancer treatment access. •Elderly patients are underrepresented in early-phase clinical trials (PhI/II).•This study evaluates the safety and efficacy of novel cancer drugs in PhI/II by age.•Grade ≥ 3 adverse events were similar across age groups, except with ADCs.•No significant age-related differences in response rate and survival outcomes.•Inclusion of elderly is crucial for generalizability of trial results.