Immunotherapy in Older Patients with Cancer: A Narrative Review

Abstract

Alexandra Smith,1,* Jeffrey Mathew Boby,2,* Steve Joseph Benny,3,* Nadia Ghazali,4,* Elke Vermeulen,1 Mathew George1 1Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia; 2Government Medical College, Kozhikode, Kerala, India; 3Government Medical College, Thrissur, Kerala, India; 4Calvary Mater Newcastle, Newcastle, NSW, Australia*These authors contributed equally to this workCorrespondence: Alexandra Smith, North West Cancer Centre, Tamworth Hospital, Dean Street, Tamworth, NSW, 2340, Australia, Email [email protected]: Immunotherapies have revolutionized cancer treatment; however, relatively little is known about their efficacy and toxicity in the elderly, a cohort accounting for more than half of total cancer cases. In this review, we aim to provide insight into the current knowledge base regarding the clinical utility and side effects of immunotherapies in the geriatric population as well as identify key gaps in the literature where further research is essential.Methods: We conducted a rapid critical review of available literature, focusing on studies reporting on use of immunotherapy in cancer patients aged ≥ 65 years. The review assessed studies that included different types of cancer, were of multiple study types (although predominantly retrospective), had different study duration, and reported different outcomes of interest. Owing to this heterogeneity, meta-analysis and a direct comparison between studies were not feasible.Results: Overall, the review findings indicate that certain malignancies have shown comparable survival rates in younger and older age groups when managed with immunotherapeutic drugs, the incidence of immunotherapy-related side effects varies only slightly by age groups, and in general there is a lack of studies on the determinants of the clinical outcomes of immunotherapy in or including geriatric patients.Conclusion: Enhanced clinical benefits along with better tolerability associated with immunotherapies make it an attractive alternative to conventional chemotherapeutic drugs, especially in elderly patients. There is currently a limited number of studies assessing the clinical outcomes of immunotherapies, particularly in the elderly. Overall, our findings reflect a need for further prospective studies focussing on geriatric patients representative of the real-life population, in order to derive a more precise understanding of the clinical utility, toxicity profile, and cost-effectiveness of immune checkpoint inhibitors in older patients with cancer.Keywords: cancer treatment, immunotherapies, geriatric oncology, toxicities

Keywords

• cancer treatment
• immunotherapies
• geriatric oncology
• toxicities