Artigo Produção Nacional Revisado por pares

Treating the elderly with immune checkpoint inhibitors: Real life experience from a large Brazilian center.

2018; Lippincott Williams & Wilkins; Volume: 36; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2018.36.15_suppl.e15077

ISSN

1527-7755

Autores

Clarissa Cavalin Silva, Daniel Herchenhorn,

Tópico(s)

Colorectal Cancer Treatments and Studies

Resumo

e15077 Background: Immune checkpoint inhibitors (ICI) have shown good efficacy and favorable safety profiles in clinical trials, but due to lack of representation of the elderly population in those studies, we currently rely on real-life data and cohorts. Treatment tolerance is a major issue in this population. Methods: Retrospective, observational study, including patients with solid malignancies above age 65, treated with FDA-approved ICI from 2015 to 2017 in our clinics in Rio de Janeiro, Brazil. Our goal was to document outcomes and identify individuals at higher risk for developing toxicities. Subjects were selected by convenience, side effects graded according Common Terminology Criteria for Adverse Events (CTCAE) v.4.0, comorbidities graded using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Results: 106 subjects were included, average age of 74,4 (65 -90), all Stage IV, with common primary sites: Lung, Melanoma, Urologic and Colorectal. Performance Status (PS) 1 in 64%, 2 in 16%, cachexia was present in 20 cases, frailty in 52, polypharmacy in 64. Mean CIRS-G was 5,76 (4-12), Nivolumab was given to 77, Pembrolizumab to 23, Ipilimumab to 4 and Atezolizumab to 2. All-grade Adverse Events (AE) occurred in 55%. 13 AE led to treatment discontinuation. There were 21 Immune-related adverse events (irAEs), most common and mild: thyroiditis, rash, pruritus. 5 severe irAEs occurred: colitis, antibody-enhanced anemia, fulminant hepatitis and polymyositis. The only predictive variable for risk to AE was frailty, OR 3,03 (95%CI 1,36 – 6,74; p 0,006). 4 patients died during treatment. Mean follow-up time was 28 weeks (4-148). 57 subjects are still on follow-up: 3 with complete response, 5 stable disease, 12 progressed and are now on chemotherapy. Conclusions: Our profile of AE’s and irAE’s is similar than reported in Literature. Frailty was the only statistically significant variable associated with development of AE. When dealing with elderly patients in the real world, having a comprehensive geriatric assessment and multidisciplinar care may indicate whether a patient develops severe AE, irAE or even dies from treatment and the value of such tools should be further investigated in prospective studies.

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