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Review
. 2021 Jun;10(6):3014-3028.
doi: 10.21037/tlcr-20-1239.

Immune checkpoint inhibitors in elderly patients treated for a lung cancer: a narrative review

Charles Naltet  1   2 , Benjamin Besse  1   3
Affiliations
Review

Immune checkpoint inhibitors in elderly patients treated for a lung cancer: a narrative review

Charles Naltet et al. Transl Lung Cancer Res. 2021 Jun.

Abstract

This article is a review of the literature concerning efficacy and safety of immune checkpoint inhibitors (ICIs) in the elderly population. In the past decade, immunotherapy deeply changed the treatment paradigm of lung cancer in particular in advanced non-small cell lung cancer (aNSCLC). Thus, ICIs have successively demonstrated a survival benefit as single agent in second line, and moved in first line as monotherapy for patients with high programmed death protein 1 (PD-L1) expression or in combination with chemotherapy regardless PD-L1 expression. If patients aged 70 years or older represent up to half of our patients in clinical routine, elderly population is significantly under-represented in clinical trials. This leads to a lack of knowledge concerning efficacy and safety of ICIs in a population of patients with frequent comorbidities, organs dysfunctions and a potential immune-senescence due to age. In this review, we described available data evaluating efficacy and safety of ICI either as monotherapy or in combination in elderly population treated for a lung cancer. These data derived from clinical trial evaluating ICIs in aNSCLC as single agent or in combination with chemotherapy or anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4). As monotherapy, older patients seem to derive the same benefit from ICIs than younger patients with no excess of toxicities. In combination with chemotherapy, real impact of ICIs in elderly population is still unclear. Results of dedicated studies evaluating ICIs as single agent or in combination in elderly patients are needed.

Keywords: Elderly; anti-programmed death ligand 1 (anti-PD-L1); anti-programmed death protein 1 (anti-PD-1); immune checkpoint inhibitors (ICIs); immunotherapy; lung cancer; non-small cell lung cancer (NSCLC); small cell lung cancer.

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-1239). The series “Immunotherapy in other thoracic malignancies and uncommon populations” was commissioned by the editorial office without any funding or sponsorship. BB served as the unpaid Guest Editor of the series. CN reports personal fees from ASTRA ZENECA, personal fees from MSD, personal fees, non-financial support and other from ROCHE, non-financial support and other from AMGEN, non-financial support and other from BMS, from TAKEDA, other from PFIZER, outside the submitted work. BB reports grants from 4D Pharma, grants from Abbvie, grants from Amgen, grants from Aptitude Health, grants from AstraZeneca, grants from BeiGene, from Blueprint Medicines, grants from BMS, grants from Boehringer Ingelheim, grants from Celgene, grants from Cergentis, grants from Cristal Therapeutics, grants from Daiichi-Sankyo, grants from Eli Lilly, grants from GSK, grants from Inivata, grants from Janssen, grants from Onxeo, grants from OSE immunotherapeutics, grants from Pfizer, grants from Roche-Genentech, grants from Sanofi, grants from Takeda, grants from Tolero Pharmaceuticals, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
HR for OS in elderly patients from phase III trials testing single agent anti-PD-1 or PD-L1 in aNSCLC. HR, hazard ratio; OS, overall survival; aNSCLC, advanced non-small cell lung cancer; ICI, immune checkpoint inhibitor; SoC, standard of care.
See this image and copyright information in PMC

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