Older adults with metastatic renal cell carcinoma(mRCC) are underrepresented in immune-checkpoint inhibitor(ICI) registration trials. Here we compare the efficacy of ICI treatments in older vs. younger adults with mRCC.
Using the International mRCC Database Consortium(IMDC), patients treated with a PD(L)-1 based ICI were identified. Older adult was defined as ≥70-years at the time of treatment. Descriptive statistics were summarized in means, medians, and proportions. Effectiveness endpoints included overall survival (OS), time-to-treatment failure(TTF), time-to-next treatment(TNT), and overall response rate(ORR). Hazards ratios were adjusted(aHR) for IMDC risk factors, histology, line of treatment and older age.
Of 1427 included patients, 397(28%) were older adults. ICI was used as 1st line(1 L) in 40%, 2nd line(2 L) in 49% and 3rd line(3 L) in 11% of patients. In univariable analysis, older adults had inferior OS compared to younger adults(25.1 m vs. 30.8 m, p < 0.01). There were no significant differences in TTF (6.9 m vs. 6.9 m, p = 0.4) or TNT(9.1 m vs 10 m, p = 0.3) between groups. In multivariable analyses, older age was not independently associated with worse OS(aHR = 1.02, p = 0.8), TTF(aHR = 0.95, p = 0.6) or TNT(aHR = 0.93, p = 0.5). Older adults had a lower ORR compared to younger adults(24% vs. 31%, p = 0.01), which was mainly driven by responses in 1 L(31% vs. 44%, p = 0.02) and not observed in 2 L/3 L.
After multivariable analyses, older adults with mRCC treated with ICI had no difference in OS, TTF or TNT when compared to younger adults. Our data support that chronological older age should not preclude patients from receiving ICI based therapies.
Journal of geriatric oncology. 2021 Mar 02 [Epub ahead of print]
Daniel V Araujo, J Connor Wells, Aaron R Hansen, Nazli Dizman, Sumanta K Pal, Benoit Beuselinck, Frede Donskov, Chun L Gan, Flora Yan, Ben Tran, Christian K Kollmannsberger, Guillermo de Velasco, Takeshi Yuasa, M Neil Reaume, D Scott Ernst, Thomas Powles, Georg A Bjarnason, Toni K Choueiri, Daniel Y C Heng, Shaan Dudani
Princess Margaret Cancer Centre, Toronto, ON, Canada., Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., City of Hope Comprehensive Cancer Center, Duarte, CA, USA., University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium., Aarhus University Hospital, Aarhus, Denmark., University of Texas Southwestern Medical Center, Dallas, TX, USA., Peter MacCallum Cancer Centre, Melbourne, Australia., BC Cancer-Vancouver Centre, Vancouver, BC, Canada., University Hospital 12 de Octubre, Madrid, Spain., Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan., The Ottawa Hospital Cancer Centre, University of Ottawa, ON, Canada., London Regional Cancer Program, London Health Sciences Centre and University of Western Ontario, London, ON, Canada., Barts Cancer Institute, Queen Mary University of London, London, United Kingdom., Sunnybrook Research Institute, Toronto, ON, Canada., Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA., William Osler Health System, Brampton, ON, Canada. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33674246