Immune Checkpoint Inhibitors in Real-World Treatment of Older Adults with Non–Small Cell Lung Cancer

Eugene Muchnik, Kah Poh Loh, Myla Strawderman, Allison Magnuson, Supriya G. Mohile, Vered Estrah, Ronald Maggiore

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non–small cell lung cancer (NSCLC) seen in routine clinical practice. DESIGN: Retrospective study. SETTING: Single academic institution and its affiliated centers. PARTICIPANTS: Patients 70 years or older with advanced-stage NSCLC seen between April 1, 2015, and April 1, 2017, and treated with ICIs. MEASUREMENTS: Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities (Charlson Comorbidity Index [CCI]), and Eastern Cooperative Oncology Group Performance Status (ECOG PS), and estimated using the Kaplan-Meier method and log-rank test. Toxicity data included immune-related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and ECOG PS were evaluated using the exact χ2 test or Fisher exact test. RESULTS: We included 75 patients (median age: 74 y; range, 70-92 y); 53% had a CCI of 3 or higher; 49% had ECOG PS of 2 or higher. Median OS for the whole cohort was 8.2 months (ECOG PS 0-1 vs ≥2: 13.7 vs 3.8 mo; p <.01). Median TTF was 4.2 months (ECOG PS 0-1 vs ≥2: 5.6 vs 2.0 mo; p =.02). Overall, 37% of patients experienced irAE of any grade (a total of 37 events); 8% were grade 3 or higher (no ICI-related deaths). Of those who discontinued ICIs (N = 64), 15% were due to irAEs. Of those who experienced irAEs, 64% required glucocorticoids. Hospitalizations during ICI treatment occurred in 72%. Toxicity generally did not differ by age, CCI, or ECOG PS. CONCLUSIONS: Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, use of glucocorticoids, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Non-Small Cell Lung Carcinoma
Comorbidity
Glucocorticoids
Hospitalization
Treatment Failure
Therapeutics
Survival
Immunotherapy
Retrospective Studies

Keywords

  • advanced stage
  • immune checkpoint inhibitors
  • non–small cell lung cancer
  • older adults

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Immune Checkpoint Inhibitors in Real-World Treatment of Older Adults with Non–Small Cell Lung Cancer. / Muchnik, Eugene; Loh, Kah Poh; Strawderman, Myla; Magnuson, Allison; Mohile, Supriya G.; Estrah, Vered; Maggiore, Ronald.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

Muchnik, Eugene ; Loh, Kah Poh ; Strawderman, Myla ; Magnuson, Allison ; Mohile, Supriya G. ; Estrah, Vered ; Maggiore, Ronald. / Immune Checkpoint Inhibitors in Real-World Treatment of Older Adults with Non–Small Cell Lung Cancer. In: Journal of the American Geriatrics Society. 2019.
@article{1a3922897f5d4e5987a12ba3f05d5c3e,
title = "Immune Checkpoint Inhibitors in Real-World Treatment of Older Adults with Non–Small Cell Lung Cancer",
abstract = "OBJECTIVE: To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non–small cell lung cancer (NSCLC) seen in routine clinical practice. DESIGN: Retrospective study. SETTING: Single academic institution and its affiliated centers. PARTICIPANTS: Patients 70 years or older with advanced-stage NSCLC seen between April 1, 2015, and April 1, 2017, and treated with ICIs. MEASUREMENTS: Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities (Charlson Comorbidity Index [CCI]), and Eastern Cooperative Oncology Group Performance Status (ECOG PS), and estimated using the Kaplan-Meier method and log-rank test. Toxicity data included immune-related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and ECOG PS were evaluated using the exact χ2 test or Fisher exact test. RESULTS: We included 75 patients (median age: 74 y; range, 70-92 y); 53{\%} had a CCI of 3 or higher; 49{\%} had ECOG PS of 2 or higher. Median OS for the whole cohort was 8.2 months (ECOG PS 0-1 vs ≥2: 13.7 vs 3.8 mo; p <.01). Median TTF was 4.2 months (ECOG PS 0-1 vs ≥2: 5.6 vs 2.0 mo; p =.02). Overall, 37{\%} of patients experienced irAE of any grade (a total of 37 events); 8{\%} were grade 3 or higher (no ICI-related deaths). Of those who discontinued ICIs (N = 64), 15{\%} were due to irAEs. Of those who experienced irAEs, 64{\%} required glucocorticoids. Hospitalizations during ICI treatment occurred in 72{\%}. Toxicity generally did not differ by age, CCI, or ECOG PS. CONCLUSIONS: Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, use of glucocorticoids, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era.",
keywords = "advanced stage, immune checkpoint inhibitors, non–small cell lung cancer, older adults",
author = "Eugene Muchnik and Loh, {Kah Poh} and Myla Strawderman and Allison Magnuson and Mohile, {Supriya G.} and Vered Estrah and Ronald Maggiore",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jgs.15750",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Immune Checkpoint Inhibitors in Real-World Treatment of Older Adults with Non–Small Cell Lung Cancer

AU - Muchnik, Eugene

AU - Loh, Kah Poh

AU - Strawderman, Myla

AU - Magnuson, Allison

AU - Mohile, Supriya G.

AU - Estrah, Vered

AU - Maggiore, Ronald

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVE: To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non–small cell lung cancer (NSCLC) seen in routine clinical practice. DESIGN: Retrospective study. SETTING: Single academic institution and its affiliated centers. PARTICIPANTS: Patients 70 years or older with advanced-stage NSCLC seen between April 1, 2015, and April 1, 2017, and treated with ICIs. MEASUREMENTS: Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities (Charlson Comorbidity Index [CCI]), and Eastern Cooperative Oncology Group Performance Status (ECOG PS), and estimated using the Kaplan-Meier method and log-rank test. Toxicity data included immune-related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and ECOG PS were evaluated using the exact χ2 test or Fisher exact test. RESULTS: We included 75 patients (median age: 74 y; range, 70-92 y); 53% had a CCI of 3 or higher; 49% had ECOG PS of 2 or higher. Median OS for the whole cohort was 8.2 months (ECOG PS 0-1 vs ≥2: 13.7 vs 3.8 mo; p <.01). Median TTF was 4.2 months (ECOG PS 0-1 vs ≥2: 5.6 vs 2.0 mo; p =.02). Overall, 37% of patients experienced irAE of any grade (a total of 37 events); 8% were grade 3 or higher (no ICI-related deaths). Of those who discontinued ICIs (N = 64), 15% were due to irAEs. Of those who experienced irAEs, 64% required glucocorticoids. Hospitalizations during ICI treatment occurred in 72%. Toxicity generally did not differ by age, CCI, or ECOG PS. CONCLUSIONS: Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, use of glucocorticoids, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era.

AB - OBJECTIVE: To evaluate the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in older patients with advanced non–small cell lung cancer (NSCLC) seen in routine clinical practice. DESIGN: Retrospective study. SETTING: Single academic institution and its affiliated centers. PARTICIPANTS: Patients 70 years or older with advanced-stage NSCLC seen between April 1, 2015, and April 1, 2017, and treated with ICIs. MEASUREMENTS: Efficacy data included overall survival (OS) and time to treatment failure (TTF), stratified by age, comorbidities (Charlson Comorbidity Index [CCI]), and Eastern Cooperative Oncology Group Performance Status (ECOG PS), and estimated using the Kaplan-Meier method and log-rank test. Toxicity data included immune-related adverse events (irAEs), need for glucocorticoids, and hospitalization. The associations of toxicity with age, CCI, and ECOG PS were evaluated using the exact χ2 test or Fisher exact test. RESULTS: We included 75 patients (median age: 74 y; range, 70-92 y); 53% had a CCI of 3 or higher; 49% had ECOG PS of 2 or higher. Median OS for the whole cohort was 8.2 months (ECOG PS 0-1 vs ≥2: 13.7 vs 3.8 mo; p <.01). Median TTF was 4.2 months (ECOG PS 0-1 vs ≥2: 5.6 vs 2.0 mo; p =.02). Overall, 37% of patients experienced irAE of any grade (a total of 37 events); 8% were grade 3 or higher (no ICI-related deaths). Of those who discontinued ICIs (N = 64), 15% were due to irAEs. Of those who experienced irAEs, 64% required glucocorticoids. Hospitalizations during ICI treatment occurred in 72%. Toxicity generally did not differ by age, CCI, or ECOG PS. CONCLUSIONS: Outcomes in our cohort were driven by ECOG PS rather than chronological age or comorbidities. The relatively high rates of ICI discontinuation, use of glucocorticoids, and hospitalization during ICI treatment in our study highlight the vulnerability of older adults with advanced NSCLC even in the immunotherapy era.

KW - advanced stage

KW - immune checkpoint inhibitors

KW - non–small cell lung cancer

KW - older adults

UR - http://www.scopus.com/inward/record.url?scp=85061039756&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061039756&partnerID=8YFLogxK

U2 - 10.1111/jgs.15750

DO - 10.1111/jgs.15750

M3 - Article

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

ER -