A prospective cohort study on the safety of checkpoint inhibitors in older cancer patients - the ELDERS study
dc.contributor.author | Gomes, Fabio | |
dc.contributor.author | Lorigan, Paul C | |
dc.contributor.author | Woolley, Sharon | |
dc.contributor.author | Foden, Philip | |
dc.contributor.author | Burns, Katy | |
dc.contributor.author | Yorke, Janelle | |
dc.contributor.author | Blackhall, Fiona H | |
dc.date.accessioned | 2021-03-08T06:18:46Z | |
dc.date.available | 2021-03-08T06:18:46Z | |
dc.date.issued | 2021 | en |
dc.identifier.citation | Gomes F, Lorigan P, Woolley S, Foden P, Burns K, Yorke J, et al. A prospective cohort study on the safety of checkpoint inhibitors in older cancer patients - the ELDERS study. ESMO Open. 2021;6(1):100042. | en |
dc.identifier.pmid | 33516147 | en |
dc.identifier.doi | 10.1016/j.esmoop.2020.100042 | en |
dc.identifier.uri | http://hdl.handle.net/10541/623781 | |
dc.description.abstract | Objective: Older cancer patients are underrepresented in the pivotal trials of checkpoint inhibitors (CPIs). This study aimed to investigate the impact of an ageing immune system on CPI-related toxicity and provide evidence for the role of geriatric assessments with CPI. Methods: The ELDERS study is a prospective observational study with two cohorts: older (70+ years of age) and younger (<70 years of age). Patients with advanced/metastatic non-small-cell lung cancer or melanoma starting single-agent CPI were eligible. The older cohort was assessed for frailty with Geriatric-8 (G8) screening, which when positive (<15 points) was followed by a holistic set of geriatric assessments. Primary endpoint was the incidence of grade 3-5 immune-related adverse events (irAEs). Results: One hundred and forty patients were enrolled with 43% being pretreated and pembrolizumab represented 92% of treatments on study. The older cohort had a significantly higher comorbidity burden (P < 0.001) and polypharmacy (P = 0.004). While 50% of older patients had a positive G8 screening, 60% on this frail subgroup had a performance status score of 0 or 1. There was no significant difference in the incidence of irAEs grade 3-5 between older and younger cohorts (18.6% versus 12.9%; odds ratio 1.55, confidence interval 95% 0.61-3.89; P = 0.353). Exposure to systemic steroids due to irAEs was numerically longer for older patients (22 versus 8 weeks; P = 0.208). A positive G8 screening predicted hospital admissions (P = 0.031) and risk of death (P = 0.01). Conclusions: The use of CPI in older patients was not associated with more high-grade toxicity. The G8 screening identified a subgroup with higher risk of AEs and its implementation should be considered in the context of CPI. | en |
dc.language.iso | en | en |
dc.relation.url | https://dx.doi.org/10.1016/j.esmoop.2020.100042 | en |
dc.title | A prospective cohort study on the safety of checkpoint inhibitors in older cancer patients - the ELDERS study | en |
dc.type | Article | en |
dc.contributor.department | Medical Oncology Department, The Christie NHS Foundation Trust, Manchester | en |
dc.identifier.journal | ESMO Open | en |
dc.description.note | en] | |
refterms.dateFOA | 2021-03-08T13:31:28Z |