Safety of immune checkpoint inhibitors in patients aged over 80 years: a retrospective cohort study

• Published in: Cancer Immunology, Immunotherapy : CII Immunotherapy : CII, 2024-05, Vol.73 (7), p.126, Article 126
• Main Authors: Ikoma, Tatsuki, Matsumoto, Toshihiko, Boku, Shogen, Motoki, Yusuke, Kinoshita, Hidefumi, Kosaka, Hisashi, Kaibori, Masaki, Inoue, Kentaro, Sekimoto, Mitsugu, Fujisawa, Takuo, Iwai, Hiroshi, Naganuma, Makoto, Tanizaki, Hideaki, Hisamatsu, Yoji, Okada, Hidetaka, Kurata, Takayasu
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Body mass index; Cancer immunotherapy; Cancer Research; Cancer therapies; Cohort analysis; Combination therapy; Cytotoxicity; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - etiology; Drugs; Female; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Immunology; Immunosuppressive agents; Immunotherapy; Incidence; Leukocytes (eosinophilic); Lymphocytes; Male; Medical records; Medicine; Medicine & Public Health; Neoplasms - drug therapy; Neoplasms - immunology; Neutrophils; Older people; Oncology; Otolaryngology; Patients; Performance evaluation; Pharmacovigilance; Proteins; Retrospective Studies; Risk Factors; Safety; Toxicity; Tumors
• ISSN: 1432-0851; 0340-7004; 1432-0851
• DOI: 10.1007/s00262-024-03707-4

Background Immuno-oncology (IO) drugs are essential for treating various cancer types; however, safety concerns persist in older patients. Although the incidence of immune-related adverse events (irAEs) is similar among age groups, higher rates of hospitalization or discontinuation of IO therapy have been reported in older patients. Limited research exists on IO drug safety and risk factors in older adults. Our investigation aimed to assess the incidence of irAEs and identify the potential risk factors associated with their development. Methods This retrospective analysis reviewed the clinical data extracted from the medical records of patients aged > 80 years who underwent IO treatment at our institution. Univariate and multivariate analyses were performed to assess the incidence of irAEs. Results Our study included 181 patients (median age: 82 years, range: 80–94), mostly men (73%), with a performance status of 0–1 in 87% of the cases; 64% received IO monotherapy. irAEs occurred in 35% of patients, contributing to IO therapy discontinuation in 19%. Our analysis highlighted increased body mass index, eosinophil counts, and albumin levels in patients with irAEs. Eosinophil count emerged as a significant risk factor for any grade irAEs, particularly Grade 3 or higher, with a cutoff of 118 (/μL). The group with eosinophil counts > 118 had a higher frequency of irAEs, and Grade 3 or higher events than the group with counts ≤ 118. Conclusion IO therapy is a safe treatment option for patients > 80 years old. Furthermore, patients with elevated eosinophil counts at treatment initiation should be cautiously managed.