Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1
are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting
in remarkable and long-lasting clinical responses. These immune checkpoint blockers
(ICBs) have already obtained approval for the treatment of patients with metastatic
melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs
enhance immune responses against cancer cells but can also lead to inflammatory side
effects called immune-related adverse events (irAEs). Such toxicities are distinct
from those associated with traditional chemotherapeutic agents or molecularly targeted
therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated
and managed appropriately. As malignancies are frequently diagnosed in older patients,
ICB treatment of elderly presents a unique challenge. However, the knowledge about
efficacy and toxicity of these molecules in this specific population is limited, as
most of the studies have involved a low number of older patients. In this review,
we will discuss about the different ICB efficacy data available for older patients.
We will then highlight the specific spectrum of immunotherapy toxicities and talk
about their management in the context of older adults.
Abbreviations:
IC (immune checkpoint), ICB (immune checkpoint blocker), irAE (immune-related adverse event), NSCLC (non-small cell lung cancer), ORR (overall response rate), OS (overall survival), RCC (renal cell carcinoma)Keywords
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Article info
Publication history
Published online: June 15, 2016
Accepted:
May 31,
2016
Received in revised form:
March 23,
2016
Received:
February 7,
2016
Identification
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© 2016 Elsevier Ltd. All rights reserved.
