The findings suggest that when it comes to selecting the appropriate treatment for older patients, there are several things to consider, she said.
For example, in the elderly population, diarrhea and colitis are associated with an increased risk of dehydration and subsequent renal failure. Also, administering prednisone could lead to delirium or altered mental status, and can be of concern due to the increased incidence of comorbid conditions such as high blood pressure and diabetes, which may be worsened by steroid therapy.
Another concern is the fact that data from the rheumatology literature suggest that infliximab in the elderly may lead to increased risk of infections; a caveat is that this was in cases involving repeated doses, Dr. Friedman noted.
Treatment discontinuation was high across the groups, with 41%, 72%, and 63% of those in the Ipi, anti–PD-1, and combination therapy groups stopping treatment early. Toxicity was the reason for discontinuation in 31%, 20%, and 50%, respectively. Progression of disease or other unrelated issues were the reasons for discontinuation in the remaining patients.
“Patients aged 80 and older treated with ipilimumab had durable survival at a rate similar to that of the general population,” Dr. Friedman said.
Further, median overall survival is prolonged in older patients treated with anti–PD-1 drugs and with combination nivolumab/ipilimumab, but not significantly.
Importantly, irAEs occur more frequently with ipilimumab-based regimens in this population, she said, noting that discontinuation rates for toxicity are also higher in those aged 80 and older.
“So given these data, as clinicians we need to start thinking about individualizing treatment for our patients – using more than just the age. Physicians should consider incorporating assessments of functional status, such as the Mini-Cog or the Get Up and Go Test when deciding which of the checkpoint antibodies is appropriate for any individual patients,” she said, adding that as the population ages, more data in the elderly population will be needed.
“Clinicians should encourage older folks to participate in immuno-oncology clinical trials, and I hope that these data will encourage physicians to consider the use of checkpoint-blocking antibodies in the treatment of other malignancy types such as non–small cell lung cancer and bladder cancer, which also have a large proportion of adults over the age of 75,” she concluded.
Dr. Friedman reported receiving funds for travel, accommodations, and expenses from Bristol-Myers Squibb.