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Associated Factors to Efficacy and Tolerance of Immunotherapy in Older Patients with Cancer Aged 70 Years and Over: Impact of Coprescriptions

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Abstract

Background

Immunotherapy with immune checkpoint blockers (ICB) significantly improves the prognosis for an increasing number of cancers. However, data on geriatric populations taking ICB are rare.

Objective

This study aimed to identify factors associated with the efficacy and tolerance of ICB in an older population.

Patients and Methods

This retrospective monocentric study included consecutive patients aged ≥ 70 years with solid cancer who received ICB between January 2018 and December 2019. Efficacy was assessed by progression-free survival (PFS) and tolerance was defined as cessation of immunotherapy due to the occurrence of any adverse event.

Results

One hundred and five patients (65.7% men) were included, mainly at the metastatic stage (95.2%); 50.5% had lung cancer. Most (80%) patients were treated with anti-PD1 (nivolumab, pembrolizumab), 19.1% with anti-PD-L1 (atezolizumab, durvalumab, and avelumab) and 0.9% with anti-CTLA4 ICB (ipilimumab). Median PFS was 3.7 months [95% confidence interval (CI) (2.75–5.70)]. PFS was shorter in univariate analysis when ICB was taken concomitantly with an antiplatelet agent (AP) [hazard ratio (HR) = 1.93; 95% CI (1.22–3.04); p = 0.005]. Tolerance was lower in univariate analysis for lung cancer [odds ratio (OR) = 3.03; 95% CI (1.07–8.56), p < 0.05] and in patients taking proton pump inhibitors (PPI) [OR = 5.50; 95% CI (1.96–15.42), p < 0.001]. There was a trend toward poorer tolerance among patients living alone [OR = 2.26; 95% CI (0.76–6.72); p = 0.14].

Conclusions

In older patients taking ICB for solid cancers, concomitant AP may influence efficacy and concomitant PPI may influence tolerance. Further studies are needed to confirm these results.

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Acknowledgments

The authors are grateful to Suzanne Rankin, a native English speaker, who read and corrected this article.

Author information

Authors and Affiliations

  1. Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France

    Marie Perret, Sophie Marilier, Pierre Jouanny, Patrick Manckoundia, Valérie Quipourt & Jérémy Barben

  2. Unit of Methodology and Biostatistics, Centre Georges François Leclerc, Dijon, France

    Aurélie Bertaut

  3. Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France

    Julie Niogret, Sophie Marilier, Leïla Bengrine-Lefevre, Valérie Quipourt & Jérémy Barben

  4. Medical Oncology Department, Centre George François Leclerc, Dijon, France

    Julie Niogret & Leïla Bengrine-Lefevre

  5. UMR INSERM U1231, University of Burgundy, Dijon, France

    Jérémy Barben

  6. UMR INSERM U1093, University of Burgundy, Dijon, France

    Patrick Manckoundia

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  1. Marie Perret
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Corresponding author

Correspondence to Jérémy Barben.

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Funding

This research received no external funding.

Competing Interests

Marie Perret, Aurélie Bertaut, Julie Niogret, Sophie Marilier, Pierre Jouanny, Patrick Manckoundia, Leïla Bengrine-Lefevre, Valérie Quipourt, and Jérémy Barben declare that they have no conflict of interest.

Ethics Approval

Ethical approval was waived by the local Ethics Committee of University of Burgundy in view of the retrospective nature of the study and since all the procedures performed were part of the routine care.

Author Contributions

Conceptualization: Jérémy Barben and Aurélie Bertaut; methodology: Aurélie Bertaut; software: Aurélie Bertaut; validation: Valérie Quipourt, Leila Bengrine-Lefevre, Julie Niogret, Pierre Jouanny, Sophie Marilier, and Patrick Manckoundia; formal analysis: Aurélie Bertaut; data curation: Marie Perret; writing—original draft preparation: Marie Perret and Jérémy Barben; writing—review and editing: Valérie Quipourt, Leila Bengrine-Lefevre, Julie Niogret, Pierre Jouanny, Sophie Marilier, and Patrick Manckoundia; supervision: Jérémy Barben.

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Not applicable.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Perret, M., Bertaut, A., Niogret, J. et al. Associated Factors to Efficacy and Tolerance of Immunotherapy in Older Patients with Cancer Aged 70 Years and Over: Impact of Coprescriptions. Drugs Aging 40, 837–846 (2023). https://doi.org/10.1007/s40266-023-01048-y

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