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Immune Checkpoint Inhibitors among the Oldest Adults with Lung Cancer, a SEER-Medicare Study
Conference poster   Peer reviewed

Immune Checkpoint Inhibitors among the Oldest Adults with Lung Cancer, a SEER-Medicare Study

A. Shaver, N. Nikita, S. Sharma, K. Gandhi, S. Keith, S. Gordon, Christopher C Yang and G. Lu-Yao
Journal of geriatric oncology, v 14(8), pS21
Nov 2023
DOI: https://doi.org/10.1016/S1879-4068(23)00302-8

Abstract

Introduction: Immune-related adverse events (irAEs) are a potentially life-threatening complication of immune checkpoint inhibitors (ICIs), a therapy commonly prescribed for Non-Small Cell Lung Cancer (NSCLC). Older adults with cancer are seldom involved in the clinical trials that inform the prescription guidelines for ICIs. Objectives: To investigate whether age affects the clinical outcomes of the oldest NSCLC patients treated with ICIs. Methods: We included adults aged ≥66 diagnosed with primary NSCLC from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked data between 1999 and 2017. We compared the frequency and time to event (TTE) of Grade 3/4 irAEs between the <80 and ≥80 age groups. Grade 3/4 irAEs were defined as events requiring a hospitalization and administration of immunomodulatory medication. All NSCLC patients in this study were followed for two years or until death. The incident rate ratio was determined through adjusted negative binomial regression, and the hazard ratio was calculated using a multivariable Cox model. Results: We identified 2,461 older adults treated with ICIs for a primary NSCLC. The most common ICI utilized was pembrolizumab, followed by nivolumab. The median TTE was 222.5 days (IQR 78.0, 293.0 days). During the study period, 61 Grade 3/4 irAEs occurred. The overall incidence rate of Grade 3/4 irAE was 2.5 per 100 person-years. The rate of Grade 3/4 irAEs among those under 80 was similar to those aged 80 and above 2.3 and 3.7 per 100 person-years, respectively. Conclusion: Though there are risks to ICI treatment, the rate of severe risks is similar in all age groups. Further studies elucidating the effective management of irAEs in the geriatric population are warranted.

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