Cancer management faces a substantial challenge posed by the aging demographic. Aging is marked by accumulated DNA damage, and this phenomenon is implicated in the process of tumorigenesis. The concept of immunosenescence, postulated to manifest in elderly individuals, is defined by an age-related decline in T cells and a simultaneous elevation in proinflammatory status, leading to a diminished efficacy in response to immunotherapy. Notably, despite the rising prevalence of cancer in the elderly population, their underrepresentation in clinical trials persists. This underscores the unmet need to evaluate the safety and efficacy of cancer treatment in the elderly. This retrospective, single-center cohort study aimed to assess and evaluate the effectiveness and safety of immunotherapy in patients compared to younger individuals with metastatic solid tumors receiving ICI. A total of 220 patients were included, mostly males, with a median age of 64. The proportion of patients ≥ 65 years old was 56.5%. The use of ICI showed no significant differences concerning overall survival (OS) and progression-free survival (PFS) among age groups across different cancer types (melanoma, non-small-cell lung cancer (NSCLC), renal, and bladder cancer;p= 0.388). Concerning the response to treatment in renal cancer patients, a significant difference was observed (p= 0.041), suggesting a potential negative impact of age on the treatment response. In patients that presented immune-related adverse events (irAEs), oral corticosteroid therapy was marginally associated (p= 0.059) with the elderly population. When evaluating the NSCLC population alone (n = 131, 59.5%), our study revealed a strong association between the development of irAEs, patients’ PFS and OS, and the duration of ICI treatment, but not directly correlated with age. The NSCLC elderly population presented a marginally greater number of irAEs, although without statistical significance (p= 0.86). ICI maintained efficacy and safety in elderly patients, challenging the notion that age alone should determine treatment decisions. The findings emphasize the necessity of a comprehensive geriatric assessment rather than relying solely on chronological age for personalized cancer treatment in the elderly population. Further prospective studies are needed to better understand immune responses in older adults and derive predictive biomarkers for cancer treatment.
人口老龄化给癌症管理带来了重大挑战。衰老以DNA损伤累积为特征，这一现象与肿瘤发生过程密切相关。免疫衰老被认为在老年个体中表现明显，其定义为T细胞随年龄增长而减少，同时促炎状态升高，导致对免疫治疗的反应效能下降。值得注意的是，尽管老年人群中癌症患病率不断上升，但他们在临床试验中的代表性仍然不足。这凸显了评估老年癌症治疗安全性和有效性的迫切需求。这项回顾性单中心队列研究旨在评估老年转移性实体瘤患者接受免疫检查点抑制剂治疗的有效性和安全性，并与年轻患者进行比较。研究共纳入220例患者，以男性为主，中位年龄64岁，其中≥65岁患者占56.5%。在不同癌种（黑色素瘤、非小细胞肺癌、肾癌和膀胱癌）中，免疫检查点抑制剂的使用在各年龄组间的总生存期和无进展生存期均未显示显著差异（p=0.388）。在肾癌患者的治疗反应方面观察到显著差异（p=0.041），提示年龄可能对治疗反应产生负面影响。在发生免疫相关不良事件的患者中，口服皮质类固醇治疗与老年人群呈边缘性相关（p=0.059）。单独评估非小细胞肺癌人群（n=131，占59.5%）时，研究发现免疫相关不良事件的发生、患者无进展生存期和总生存期与免疫检查点抑制剂治疗持续时间密切相关，但与年龄无直接相关性。老年非小细胞肺癌患者出现免疫相关不良事件的数量略多，但无统计学意义（p=0.86）。免疫检查点抑制剂在老年患者中保持疗效和安全性，这对仅凭年龄决定治疗决策的观念提出了挑战。研究结果强调，在老年人群的个体化癌症治疗中，需要进行全面的老年综合评估，而非仅仅依赖实际年龄。需要进一步的前瞻性研究来更好地理解老年人的免疫反应，并开发癌症治疗的预测性生物标志物。
肿瘤(癌症)患者之家