Real-World Prevalence and Tolerability of Immune-Related Adverse Events in Older Adults with Non-Small Cell Lung Cancer: A Multi-Institutional Retrospective Study.

Simple Summary: Immune checkpoint inhibitors (ICIs) represent a cornerstone in contemporary cancer therapy, yet managing immune-related adverse events (irAEs) remains pivotal. These events, characterized by reinvigorated autoimmune responses against normal tissues, present particular challenges, especially regarding their safety and tolerability in elderly patients. To address this gap, we conducted a multicenter retrospective cohort study focusing on patients with non-small cell lung cancer undergoing ICI therapy. Our findings revealed that irAE incidence, severity, and organ specificity did not significantly differ between elderly patients and their younger counterparts. However, elderly patients tended to transition to the best supportive care following irAE onset. These findings suggest that while age alone may not preclude ICI treatment, irAEs may be less tolerated in certain elderly individuals, potentially impacting patient prognosis. Identifying markers of irAE intolerance, such as frailty, sarcopenia, and cachexia, alongside chronological age, could aid in optimizing patient selection and clinical benefits of ICI treatment in this population. With cancer diagnosis occurring at older ages, the use of immune checkpoint inhibitors (ICIs) has extended to older adults. However, the safety of immune-related adverse events (irAEs) in this population remains unclear and relies on data extrapolated from younger adults. This multicenter retrospective study aimed to examine irAE prevalence and tolerability in older adults. We included 436 patients with non-small lung cancer undergoing ICI therapy and dichotomized them into two age groups (< or ≥75 years). Incidence of any irAE grade, grade ≥3 irAEs, and steroid usage after irAE occurrence was similar between younger (n = 332) and older groups (n = 104). While the younger patients with irAEs showed prolonged overall survival in the 12-month landmark Kaplan–Meier analysis (Hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.38–0.89, p = 0.013), the older cohort did not (HR 0.80, 95% CI 0.36–1.78, p = 0.588). Although no differences were observed with ICI continuation or re-challenge after irAE onset, the elderly cohort had double the irAE cases that required a transition to best supportive care (BSC) (11.3% vs. 22.4%, p = 0.026). In conclusion, although irAE prevalence remains consistent regardless of age, the increased conversion to BSC post-irAE onset in older adults suggests diminished tolerability and the potential absence of favorable prognosis associated with irAEs in this population. [ABSTRACT FROM AUTHOR]

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