Elderly in need of immunotherapy? Can they tolerate it? Can they gain a response? YES, they can!!!

I've noted that elderly patients can not only tolerate but respond to immunotherapy as well as the rest of us before:  Elderly melanoma patients and immunotherapy

Now, there's this:

Older melanoma patients aged 75 and above retain responsiveness to anti-PD1 therapy: results of a retrospective single-institution cohort study.  Ibrahim, Mateus, Baz, Robert. Cancer Immunol Immunother. 2018 Jul 28.  

The utility of immunotherapy in elderly melanoma patients is debated. We aimed in this study to evaluate the efficacy and tolerability of immunotherapy among elderly patients.

This is a retrospective single-institution cohort study. Patients aged 75 years and above who had been treated with nivolumab, pembrolizumab or ipilimumab for advanced or metastatic melanoma, were included. Patients and disease characteristics were collected using electronic medical records. Objective response was determined according to the immune-related response criteria. Drug-related toxicities (DRT) were graded according to the CTCAE v4.03.

99 patients were included with a mean age of 80 years. One patient received nivolumab and ipilimumab combination, but died because of drug-related diverticulitis. Median PFS on pembrolizumab, nivolumab or ipilimumab were equal to 11.9, 1.4, and 2.8 months, respectively, while objective response rates were equal to 51.6, 12.5, and 17.3%, respectively. Median OS was not reached in patients who received only pembrolizumab, 8.7 months in the ipilimumab only group, and 23 months in patients receiving several immune therapies sequentially. Pembrolizumab, nivolumab, and ipilimumab grade 3-4 DRT rates were equal to 24.2, 62.5, and 32.7% respectively, while discontinuation rates were equal to 43.5, 62.5, and 28.8%, respectively.

Our study suggests that immunotherapy is effective and well tolerated in the elderly. The PFS on pembrolizumab was greater than expected, a finding that needs to be investigated further.

Ok.  Don't know why they are confused by their pembro results...they seem in keeping with what we know already and this is a small sample.  But, so be it.  The elderly peeps tolerated and responded to immunotherapy as well as ratties in other age groups! 

There is also this:

The efficacy and toxicity of immune checkpoint inhibitors in a real-world older patient population. Sattar, Kartolo, Hopman, et al. J Geriatr Oncol. 2018 Aug 10.

Immunotherapy has emerged as an effective treatment option for the management of advanced cancers. The effects of these immune checkpoint inhibitors in the older patient population has not been adequately assessed.  To understand the impact of aging on CTLA-4 and PDL-1 inhibitors efficacy and immune-related adverse events (irAE) in the context of real-world management of advanced solid cancers.

This retrospective study involved all non-study patients with histologically-confirmed metastatic or inoperable solid cancers receiving immunotherapy at Kingston Health Sciences Centre. We defined 'older patient' as age greater than/= to 75. All statistical analyses were conducted under SPSS IBM for Windows version 24.0. Study outcomes included immunotherapy treatment response, survival, as well as number, type, and severity of irAEs.

Our study (N = 78) had 29 (37%) patients age less than 65, 26 (33%) patients age 65-74, and 23 (30%) patients age greater than/= than 75. Melanoma, non-small cell lung cancer, and renal cell carcinoma accounted for 70%, 22%, and 8% of the study population, respectively. Distributions of ipilimumab (32%), nivolumab (33%), and pembrolizumab (35%) were similar in the study. The response rates were 28%, 27%, and 39% in the age less than 65, age 64-74, age greater than/= to 75 groups, respectively. Kaplan-Meier curve showed a median survival of 28 months (12.28-43.9) and 17 months (0-36.9) in the age less than 65 and age 64-74 groups, respectively; the estimated survival probability did not reach 50% in the age greater than/= to 75 group. There were no statistically significant differences found in terms of irAEs, multiple irAEs, severity of grade 3 or higher, types of irAEs, and irAEs resolution status when comparing between different age groups.  

Our results suggest that patients age greater than/= to 75 are able to gain as much benefit from immunotherapy as younger patients, without excess toxicity. Our findings suggest that single agent immunotherapy is generally well-tolerated across different age groups with no significant difference in the type, frequency or severity of irAEs. Future studies evaluating aging and combination immunotherapy are warranted.

Again, elderly peeps gained responses and dealt with side effects to immunotherapy in a fashion similar to previously studied populations.

Ratties are ratties, no matter their age!!!  Good to know if you or your loved one "of a certain age" are in need! - c