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Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study

Background: Immunotherapy has completely changed the treatment of solid tumors. Although immune checkpoint inhibitors (ICIs) seem to be an appealing alternative to chemotherapy, especially in elderly patients, due to a more tolerable toxicity profile, they can lead to a peculiar variety of immune-re...

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Autores principales: Paderi, Agnese, Fancelli, Sara, Caliman, Enrico, Pillozzi, Serena, Gambale, Elisabetta, Mela, Marinella Micol, Doni, Laura, Mazzoni, Francesca, Antonuzzo, Lorenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395507/
https://www.ncbi.nlm.nih.gov/pubmed/34449588
http://dx.doi.org/10.3390/curroncol28050283
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author Paderi, Agnese
Fancelli, Sara
Caliman, Enrico
Pillozzi, Serena
Gambale, Elisabetta
Mela, Marinella Micol
Doni, Laura
Mazzoni, Francesca
Antonuzzo, Lorenzo
author_facet Paderi, Agnese
Fancelli, Sara
Caliman, Enrico
Pillozzi, Serena
Gambale, Elisabetta
Mela, Marinella Micol
Doni, Laura
Mazzoni, Francesca
Antonuzzo, Lorenzo
author_sort Paderi, Agnese
collection PubMed
description Background: Immunotherapy has completely changed the treatment of solid tumors. Although immune checkpoint inhibitors (ICIs) seem to be an appealing alternative to chemotherapy, especially in elderly patients, due to a more tolerable toxicity profile, they can lead to a peculiar variety of immune-related adverse events (irAEs). However, data on tolerability and outcome of ICIs in the elderly are lacking due to poor accrual in clinical trials of these patients. Methods: We performed a retro-prospective analysis on patients treated with single agent anti-PD-L1/PD-1 at the Clinical Oncology Unit, Careggi University Hospital, from March 2016 to March 2020. Data on the treatment responses, type and severity of irAEs, as well as the corticosteroids (CCS) dosage used for irAEs and the discontinuation rate, were described per each patient, according to two different age-based cohorts of patients (< or ≥70 years). Results: We reported a lower incidence of all-grade toxicity in elderly compared to younger patients (64.9% vs. 44.9%, p = 0.018). The two age-cohorts showed a different profile of irAEs. Endocrine irAEs were significantly higher in younger patients (39.7% vs. 21.7%, p = 0.002), while dermatologic toxicities were more common in the older group (35.0% vs. 11.3%, p = 0.047). Use of CCS and treatment discontinuation rate do not differ significantly between the two age groups. Conclusion: Our findings suggest that treatment with ICIs in elderly populations is safe and feasible. Patients over 70 years are more prone to develop skin irAEs, while younger patients are more subject to experience endocrine toxicities.
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spelling pubmed-83955072021-08-28 Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study Paderi, Agnese Fancelli, Sara Caliman, Enrico Pillozzi, Serena Gambale, Elisabetta Mela, Marinella Micol Doni, Laura Mazzoni, Francesca Antonuzzo, Lorenzo Curr Oncol Article Background: Immunotherapy has completely changed the treatment of solid tumors. Although immune checkpoint inhibitors (ICIs) seem to be an appealing alternative to chemotherapy, especially in elderly patients, due to a more tolerable toxicity profile, they can lead to a peculiar variety of immune-related adverse events (irAEs). However, data on tolerability and outcome of ICIs in the elderly are lacking due to poor accrual in clinical trials of these patients. Methods: We performed a retro-prospective analysis on patients treated with single agent anti-PD-L1/PD-1 at the Clinical Oncology Unit, Careggi University Hospital, from March 2016 to March 2020. Data on the treatment responses, type and severity of irAEs, as well as the corticosteroids (CCS) dosage used for irAEs and the discontinuation rate, were described per each patient, according to two different age-based cohorts of patients (< or ≥70 years). Results: We reported a lower incidence of all-grade toxicity in elderly compared to younger patients (64.9% vs. 44.9%, p = 0.018). The two age-cohorts showed a different profile of irAEs. Endocrine irAEs were significantly higher in younger patients (39.7% vs. 21.7%, p = 0.002), while dermatologic toxicities were more common in the older group (35.0% vs. 11.3%, p = 0.047). Use of CCS and treatment discontinuation rate do not differ significantly between the two age groups. Conclusion: Our findings suggest that treatment with ICIs in elderly populations is safe and feasible. Patients over 70 years are more prone to develop skin irAEs, while younger patients are more subject to experience endocrine toxicities. MDPI 2021-08-25 /pmc/articles/PMC8395507/ /pubmed/34449588 http://dx.doi.org/10.3390/curroncol28050283 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Paderi, Agnese
Fancelli, Sara
Caliman, Enrico
Pillozzi, Serena
Gambale, Elisabetta
Mela, Marinella Micol
Doni, Laura
Mazzoni, Francesca
Antonuzzo, Lorenzo
Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study
title Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study
title_full Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study
title_fullStr Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study
title_full_unstemmed Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study
title_short Safety of Immune Checkpoint Inhibitors in Elderly Patients: An Observational Study
title_sort safety of immune checkpoint inhibitors in elderly patients: an observational study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395507/
https://www.ncbi.nlm.nih.gov/pubmed/34449588
http://dx.doi.org/10.3390/curroncol28050283
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