Real-world survival outcomes in patients with different types of cancer managed with immune checkpoint inhibitors.

Abstract

Introduction: Immune checkpoint inhibitors (ICI) are now standard of care in systemic treatment for many types of metastatic cancer, often together with cytotoxic chemotherapy. Monitoring of treatment efficacy against clinical trial benchmarks in real-world populations and subgroups such as elderly patients is necessary. Based on the results of a previous study, we evaluated age-related survival differences in a larger cohort.

Methods: Retrospective analysis of 272 patients managed in a rural real-world setting, after exclusion of those who had received neoadjuvant, adjuvant or maintenance ICI treatment. We defined four different survival categories: death within 3 months of the first ICI dose, 3-6 months survival, 6-12 months survival, and >12 months survival. All surviving patients were followed for >12 months. Actuarial overall survival was assessed too. Age was stratified in 10-year increments.

Results: Non-small cell lung cancer (NSCLC) and malignant melanoma represented the most common tumor types. Median age was 70 years. Median actuarial overall survival was 13.6 months (5-year estimate 16%). The best survival was recorded in patients 61-70 years of age. The highest rate of early death within 3 months (29%) was seen in those aged >80 years. Long-term survival was not observed in this age-group, in contrast to all others.

Conclusion: Satisfactory survival was observed in this elderly patient cohort, but survival varied with tumor type and performance status. Age was not a major determinant of survival. However, the oldest patients were at higher risk of short survival.