With cancer diagnosis occurring at older ages, the use of immune checkpoint inhibitors (ICIs) has extended to older adults. However, the safety of immune-related adverse events (irAEs) in this population remains unclear and relies on data extrapolated from younger adults. This multicenter retrospective study aimed to examine irAE prevalence and tolerability in older adults. We included 436 patients with non-small lung cancer undergoing ICI therapy and dichotomized them into two age groups (< or ≥75 years). Incidence of any irAE grade, grade ≥3 irAEs, and steroid usage after irAE occurrence was similar between younger (n = 332) and older groups (n = 104). While the younger patients with irAEs showed prolonged overall survival in the 12-month landmark Kaplan–Meier analysis (Hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.38–0.89,p= 0.013), the older cohort did not (HR 0.80, 95% CI 0.36–1.78,p= 0.588). Although no differences were observed with ICI continuation or re-challenge after irAE onset, the elderly cohort had double the irAE cases that required a transition to best supportive care (BSC) (11.3% vs. 22.4%,p= 0.026). In conclusion, although irAE prevalence remains consistent regardless of age, the increased conversion to BSC post-irAE onset in older adults suggests diminished tolerability and the potential absence of favorable prognosis associated with irAEs in this population.
随着癌症诊断年龄的增高，免疫检查点抑制剂（ICIs）的应用已扩展至老年人群。然而，该人群中免疫相关不良事件（irAEs）的安全性仍不明确，且依赖于从年轻成人数据中推断的结果。本项多中心回顾性研究旨在探讨老年患者中irAEs的发生率及耐受性。研究纳入436例接受ICI治疗的非小细胞肺癌患者，并按年龄分为两组（<75岁或≥75岁）。结果显示，年轻组（n=332）与老年组（n=104）在任何级别irAE发生率、≥3级irAE发生率以及irAE发生后类固醇使用率方面均无显著差异。在12个月界标Kaplan–Meier分析中，发生irAE的年轻患者总生存期显著延长（风险比（HR）0.59，95%置信区间（CI）0.38–0.89，p=0.013），而老年患者则未观察到类似获益（HR 0.80，95% CI 0.36–1.78，p=0.588）。尽管在irAE发生后继续或再次使用ICI方面未观察到组间差异，但老年组中因irAE需转为最佳支持治疗（BSC）的患者比例是年轻组的两倍（11.3% vs. 22.4%，p=0.026）。综上所述，尽管irAE发生率在不同年龄组间保持一致，但老年患者irAE发生后转为BSC的比例升高，提示该人群对irAE的耐受性降低，且irAEs可能未带来相应的预后获益。
肿瘤(癌症)患者之家