Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer
Despite growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response, the relationship between immune-related adverse events (irAEs) and overall survival (OS) among older adults [age ≥ 70 years (y)] remains unknown. The study goal was to deter...
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| Veröffentlicht in: | Journal of geriatric oncology 2021-06, Vol.12 (5), p.813-819 |
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| creator | Johns, Andrew C. Wei, Lai Grogan, Madison Hoyd, Rebecca Bridges, John F.P. Patel, Sandipkumar H. Li, Mingjia Husain, Marium Kendra, Kari L. Otterson, Gregory A. Burkart, Jarred T. Rosko, Ashley E. Andersen, Barbara L. Carbone, David P. Owen, Dwight H. Spakowicz, Daniel J. Presley, Carolyn J. |
| description | Despite growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response, the relationship between immune-related adverse events (irAEs) and overall survival (OS) among older adults [age ≥ 70 years (y)] remains unknown. The study goal was to determine differences in OS based on age and ≥ grade 3 (G3) irAEs.
This was a retrospective cohort study of 673 patients with advanced cancer. Patients who received ≥1 dose of IO at our institution from 2011 to 2018 were eligible. The primary outcome was OS from the start of first line of IO treatment, compared between four patient groups stratified by age and ≥ G3 irAEs with adjustment for patient characteristics using a Cox proportional hazards model.
Among all 673 patients, 35.4% were ≥ 70y, 39.8% had melanoma, and 45.6% received single-agent nivolumab. Incidence and types of ≥G3 irAEs did not differ by age. Median OS was significantly longer for all patients with ≥G3 irAEs (unadjusted 21.7 vs. 11.9 months, P = 0.007). There was no difference in OS among patients ≥70y with ≥G3 irAEs (HR 0.94, 95% CI 0.61–1.47, P = 0.79) in the multivariable analysis. Patients |
| doi_str_mv | 10.1016/j.jgo.2021.02.002 |
| format | Article |
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This was a retrospective cohort study of 673 patients with advanced cancer. Patients who received ≥1 dose of IO at our institution from 2011 to 2018 were eligible. The primary outcome was OS from the start of first line of IO treatment, compared between four patient groups stratified by age and ≥ G3 irAEs with adjustment for patient characteristics using a Cox proportional hazards model.
Among all 673 patients, 35.4% were ≥ 70y, 39.8% had melanoma, and 45.6% received single-agent nivolumab. Incidence and types of ≥G3 irAEs did not differ by age. Median OS was significantly longer for all patients with ≥G3 irAEs (unadjusted 21.7 vs. 11.9 months, P = 0.007). There was no difference in OS among patients ≥70y with ≥G3 irAEs (HR 0.94, 95% CI 0.61–1.47, P = 0.79) in the multivariable analysis. Patients <70y with ≥G3 irAEs had significantly increased OS (HR 0.33, 95% CI 0.21–0.52, P < 0.001). Younger patients, but not older adults, with high-grade irAEs experience strong survival benefit. This difference may be due to the toll of irAEs themselves or the effects of treatments for irAEs, such as corticosteroids. Factors impacting OS of older adults after irAEs must be determined and optimized.</description><identifier>ISSN: 1879-4068</identifier><identifier>ISSN: 1879-4076</identifier><identifier>EISSN: 1879-4076</identifier><identifier>DOI: 10.1016/j.jgo.2021.02.002</identifier><identifier>PMID: 33627226</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Aged ; Cancer ; Checkpoint inhibitors ; Humans ; Immune-related adverse events ; Immunologic Factors ; Immunotherapy - adverse effects ; Melanoma - drug therapy ; Nivolumab - adverse effects ; Older adults ; Overall survival ; Retrospective Studies ; Toxicity</subject><ispartof>Journal of geriatric oncology, 2021-06, Vol.12 (5), p.813-819</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-1ec6c1fbb84c5fe2d4a0310e2fdb124b6c703eddb7490c94e2e3051fdce2fe93</citedby><cites>FETCH-LOGICAL-c451t-1ec6c1fbb84c5fe2d4a0310e2fdb124b6c703eddb7490c94e2e3051fdce2fe93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jgo.2021.02.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33627226$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Johns, Andrew C.</creatorcontrib><creatorcontrib>Wei, Lai</creatorcontrib><creatorcontrib>Grogan, Madison</creatorcontrib><creatorcontrib>Hoyd, Rebecca</creatorcontrib><creatorcontrib>Bridges, John F.P.</creatorcontrib><creatorcontrib>Patel, Sandipkumar H.</creatorcontrib><creatorcontrib>Li, Mingjia</creatorcontrib><creatorcontrib>Husain, Marium</creatorcontrib><creatorcontrib>Kendra, Kari L.</creatorcontrib><creatorcontrib>Otterson, Gregory A.</creatorcontrib><creatorcontrib>Burkart, Jarred T.</creatorcontrib><creatorcontrib>Rosko, Ashley E.</creatorcontrib><creatorcontrib>Andersen, Barbara L.</creatorcontrib><creatorcontrib>Carbone, David P.</creatorcontrib><creatorcontrib>Owen, Dwight H.</creatorcontrib><creatorcontrib>Spakowicz, Daniel J.</creatorcontrib><creatorcontrib>Presley, Carolyn J.</creatorcontrib><title>Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer</title><title>Journal of geriatric oncology</title><addtitle>J Geriatr Oncol</addtitle><description>Despite growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response, the relationship between immune-related adverse events (irAEs) and overall survival (OS) among older adults [age ≥ 70 years (y)] remains unknown. The study goal was to determine differences in OS based on age and ≥ grade 3 (G3) irAEs.
This was a retrospective cohort study of 673 patients with advanced cancer. Patients who received ≥1 dose of IO at our institution from 2011 to 2018 were eligible. The primary outcome was OS from the start of first line of IO treatment, compared between four patient groups stratified by age and ≥ G3 irAEs with adjustment for patient characteristics using a Cox proportional hazards model.
Among all 673 patients, 35.4% were ≥ 70y, 39.8% had melanoma, and 45.6% received single-agent nivolumab. Incidence and types of ≥G3 irAEs did not differ by age. Median OS was significantly longer for all patients with ≥G3 irAEs (unadjusted 21.7 vs. 11.9 months, P = 0.007). There was no difference in OS among patients ≥70y with ≥G3 irAEs (HR 0.94, 95% CI 0.61–1.47, P = 0.79) in the multivariable analysis. Patients <70y with ≥G3 irAEs had significantly increased OS (HR 0.33, 95% CI 0.21–0.52, P < 0.001). Younger patients, but not older adults, with high-grade irAEs experience strong survival benefit. This difference may be due to the toll of irAEs themselves or the effects of treatments for irAEs, such as corticosteroids. Factors impacting OS of older adults after irAEs must be determined and optimized.</description><subject>Aged</subject><subject>Cancer</subject><subject>Checkpoint inhibitors</subject><subject>Humans</subject><subject>Immune-related adverse events</subject><subject>Immunologic Factors</subject><subject>Immunotherapy - adverse effects</subject><subject>Melanoma - drug therapy</subject><subject>Nivolumab - adverse effects</subject><subject>Older adults</subject><subject>Overall survival</subject><subject>Retrospective Studies</subject><subject>Toxicity</subject><issn>1879-4068</issn><issn>1879-4076</issn><issn>1879-4076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1r3DAQhkVoSUKSH9BL0bGXdfW1sk2hUJa2KQRyyV3I0nitrS1tJdnN_vtq2WRpL9VlhtEz7wzzIvSOkooSKj_uqt02VIwwWhFWEcIu0DVt6nYlSC3fnHPZXKG7lHakPM7atpaX6IpzyWrG5DUaNgOYn_vgfMbOD65zOUTspmn2IQ8Q9f6Ac3h2xuUD1t7isJTiOOI0x8UtesR6Cn6Lw2ghYm3nMSf82-Wh5Iv2Biw2xxBv0dtejwnuXuINevr29Wlzv3p4_P5j8-VhZcSa5hUFIw3tu64RZt0Ds0ITTgmw3naUiU6amnCwtqtFS0wrgAEna9pbUxBo-Q36fJLdz90EpepzWVfto5t0PKignfr3x7tBbcOiGtoISZoi8OFFIIZfM6SsJpcMjKP2EOakmGi5WEvekILSE2piSClCfx5DiTp6pHaqeKSOHinCVPGo9Lz_e79zx6sjBfh0AqAcaXEQVTIOjod0EUxWNrj_yP8BlEymXQ</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Johns, Andrew C.</creator><creator>Wei, Lai</creator><creator>Grogan, Madison</creator><creator>Hoyd, Rebecca</creator><creator>Bridges, John F.P.</creator><creator>Patel, Sandipkumar H.</creator><creator>Li, Mingjia</creator><creator>Husain, Marium</creator><creator>Kendra, Kari L.</creator><creator>Otterson, Gregory A.</creator><creator>Burkart, Jarred T.</creator><creator>Rosko, Ashley E.</creator><creator>Andersen, Barbara L.</creator><creator>Carbone, David P.</creator><creator>Owen, Dwight H.</creator><creator>Spakowicz, Daniel J.</creator><creator>Presley, Carolyn J.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210601</creationdate><title>Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer</title><author>Johns, Andrew C. ; Wei, Lai ; Grogan, Madison ; Hoyd, Rebecca ; Bridges, John F.P. ; Patel, Sandipkumar H. ; Li, Mingjia ; Husain, Marium ; Kendra, Kari L. ; Otterson, Gregory A. ; Burkart, Jarred T. ; Rosko, Ashley E. ; Andersen, Barbara L. ; Carbone, David P. ; Owen, Dwight H. ; Spakowicz, Daniel J. ; Presley, Carolyn J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-1ec6c1fbb84c5fe2d4a0310e2fdb124b6c703eddb7490c94e2e3051fdce2fe93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Cancer</topic><topic>Checkpoint inhibitors</topic><topic>Humans</topic><topic>Immune-related adverse events</topic><topic>Immunologic Factors</topic><topic>Immunotherapy - adverse effects</topic><topic>Melanoma - drug therapy</topic><topic>Nivolumab - adverse effects</topic><topic>Older adults</topic><topic>Overall survival</topic><topic>Retrospective Studies</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Johns, Andrew C.</creatorcontrib><creatorcontrib>Wei, Lai</creatorcontrib><creatorcontrib>Grogan, Madison</creatorcontrib><creatorcontrib>Hoyd, Rebecca</creatorcontrib><creatorcontrib>Bridges, John F.P.</creatorcontrib><creatorcontrib>Patel, Sandipkumar H.</creatorcontrib><creatorcontrib>Li, Mingjia</creatorcontrib><creatorcontrib>Husain, Marium</creatorcontrib><creatorcontrib>Kendra, Kari L.</creatorcontrib><creatorcontrib>Otterson, Gregory A.</creatorcontrib><creatorcontrib>Burkart, Jarred T.</creatorcontrib><creatorcontrib>Rosko, Ashley E.</creatorcontrib><creatorcontrib>Andersen, Barbara L.</creatorcontrib><creatorcontrib>Carbone, David P.</creatorcontrib><creatorcontrib>Owen, Dwight H.</creatorcontrib><creatorcontrib>Spakowicz, Daniel J.</creatorcontrib><creatorcontrib>Presley, Carolyn J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of geriatric oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Johns, Andrew C.</au><au>Wei, Lai</au><au>Grogan, Madison</au><au>Hoyd, Rebecca</au><au>Bridges, John F.P.</au><au>Patel, Sandipkumar H.</au><au>Li, Mingjia</au><au>Husain, Marium</au><au>Kendra, Kari L.</au><au>Otterson, Gregory A.</au><au>Burkart, Jarred T.</au><au>Rosko, Ashley E.</au><au>Andersen, Barbara L.</au><au>Carbone, David P.</au><au>Owen, Dwight H.</au><au>Spakowicz, Daniel J.</au><au>Presley, Carolyn J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer</atitle><jtitle>Journal of geriatric oncology</jtitle><addtitle>J Geriatr Oncol</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>12</volume><issue>5</issue><spage>813</spage><epage>819</epage><pages>813-819</pages><issn>1879-4068</issn><issn>1879-4076</issn><eissn>1879-4076</eissn><abstract>Despite growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response, the relationship between immune-related adverse events (irAEs) and overall survival (OS) among older adults [age ≥ 70 years (y)] remains unknown. The study goal was to determine differences in OS based on age and ≥ grade 3 (G3) irAEs.
This was a retrospective cohort study of 673 patients with advanced cancer. Patients who received ≥1 dose of IO at our institution from 2011 to 2018 were eligible. The primary outcome was OS from the start of first line of IO treatment, compared between four patient groups stratified by age and ≥ G3 irAEs with adjustment for patient characteristics using a Cox proportional hazards model.
Among all 673 patients, 35.4% were ≥ 70y, 39.8% had melanoma, and 45.6% received single-agent nivolumab. Incidence and types of ≥G3 irAEs did not differ by age. Median OS was significantly longer for all patients with ≥G3 irAEs (unadjusted 21.7 vs. 11.9 months, P = 0.007). There was no difference in OS among patients ≥70y with ≥G3 irAEs (HR 0.94, 95% CI 0.61–1.47, P = 0.79) in the multivariable analysis. Patients <70y with ≥G3 irAEs had significantly increased OS (HR 0.33, 95% CI 0.21–0.52, P < 0.001). Younger patients, but not older adults, with high-grade irAEs experience strong survival benefit. This difference may be due to the toll of irAEs themselves or the effects of treatments for irAEs, such as corticosteroids. Factors impacting OS of older adults after irAEs must be determined and optimized.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>33627226</pmid><doi>10.1016/j.jgo.2021.02.002</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cancer Checkpoint inhibitors Humans Immune-related adverse events Immunologic Factors Immunotherapy - adverse effects Melanoma - drug therapy Nivolumab - adverse effects Older adults Overall survival Retrospective Studies Toxicity |
| title | Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer |
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