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Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 270-276

Immune checkpoint inhibitors in older patients with solid tumors: Real-world experience from India

Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India

Correspondence Address:
Vanita Noronha
Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_86_21

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Background: Older patients with cancer are underrepresented in most immunotherapy trials. Therefore, there is an urgent and unmet need for real-world data on the efficacy and safety of immune checkpoint inhibitors (ICIs) in older patients with cancer. Objectives: This study was aimed at analyzing the demographic pattern, treatment-related outcomes, and toxicities of ICIs in older patients with solid tumors. Materials and Methods: This retrospective study was conducted in the Department of Medical Oncology of the Tata Memorial Hospital, a tertiary cancer care center in Mumbai, India. Patients aged ≥ 60 years with histologically confirmed malignancies of the thoracic, head and neck and genitourinary systems who were treated with ICIs between August 2014 and February 2021, and had received at least 2 cycles of ICI were enrolled in the study. Data related to the demographic profile and pattern of care were obtained from the electronic medical records and physical patient files. Patient management was decided in a multidisciplinary tumor board meeting. The primary endpoint of the study was overall survival (OS). The secondary endpoints were objective response rate (ORR), progression-free survival (PFS), and rate of immune-related adverse events. Results: There were 150 patients included in the study. The most common indications for ICI use were non-small-cell lung cancer (52.7%) and head and neck squamous cell carcinoma (17.3%). Nivolumab was the most common ICI used in 119 (79.4%) patients. ICIs were used in the palliative setting in 144 (96%) patients. A total of 76 (50.6%) patients received ICIs as second-line therapy. The median number of cycles of ICI received was 5 (interquartile range, 3.0–9.5). The ORR to ICIs was 30%, and the clinical benefit rate was 52%. ICIs were discontinued due to toxicities in 4 (2.7%) patients. The median PFS and OS were 4.23 (95% confidence interval [CI], 1.38–7.08) months and 8.6 (95% CI, 4.9–12.2) months, respectively. Baseline performance status was the most significant prognostic factor for PFS and OS in the multivariate analysis. In addition, age, male sex, and comorbid conditions such as chronic kidney disease negatively impacted the OS. Conclusion: Our study shows that ICIs are efficacious and well tolerated in older Indian patients with solid tumors. There is an emerging need for larger prospective studies on ICIs with the incorporation of geriatric assessment scores in this vulnerable patient population.

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