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Mourey L, Rainho LT, Dalban C, Carril-Ajuria L, Negrier S, Chevreau C, Gravis G, Thibault C, Laguerre B, Barthelemy P, Borchiellini D, Gross-Goupil M, Geoffrois L, Rolland F, Thiery-Vuillemin A, Tantot F, Chaput N, Naigeon M, Teixeira M, Escudier B, Flippot R, Albiges L. Safety and efficacy of nivolumab in elderly patients with metastatic clear cell renal cell carcinoma: Analysis of the NIVOREN GETUG-AFU 26 study. Eur J Cancer 2024; 201:113589. [PMID: 38382153 DOI: 10.1016/j.ejca.2024.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Immune checkpoint inhibitors are standard of care in metastatic renal cell carcinoma but their activity and safety in elderly patients is insufficiently explored. We evaluated outcomes of elderly patients with mRCC treated with nivolumab in the GETUG-AFU 26 NIVOREN phase 2 trial (NCT03013335) and conducted exploratory circulating biomarker analyses. METHODS Patients with mRCC were treated with nivolumab after at least one antiangiogenic therapy. The main endpoint of this analysis was safety in patients ≥ 70 years old (y.o), as per the rate of treatment-related grade 3-5 events (TRAE). Secondary endpoints included overall response rate (ORR), progression-free survival (PFS), overall survival. Exploration of candidate biomarkers associated with aging included baseline circulating cytokines involved in inflammation, adhesion, immune checkpoints, angiogenesis (IL6, IL7, IL8, BAFF, CXCL13, VCAM-1, 4-1BB, VEGF). RESULTS Of 720 patients, 515 were < 70 y.o and 205 ≥ 70 y.o. Patients ≥ 70 y.o exhibited numerically less IMDC poor risk disease (21.0% vs 26.9%), sarcomatoid component (4.9% vs 9.8%) or brain metastases (5.9% vs. 14.7%), but more previous treatment lines (≥ 2 in 54.1% vs 48.5%). TRAE were higher in patients ≥ 70 y.o (24.9% vs. 17.9%, p = 0.033). Respective ORR (19.2% vs. 22.1%) and median PFS (4.5 versus 3.0 months, HR 0.97 [95%CI 0.81-1.15]) were similar. Overall survival was shorter in patients ≥ 70 y.o (19.3 versus 26.9 months, HR 1.26 [95%CI 1.04-1.51]), but not significantly in a competitive risk model. Only V-CAM1 and 4-1BB were found to be increased in patients ≥ 70 y.o. CONCLUSIONS Nivolumab displayed higher grade 3/4 TRAE but manageable toxicity in elderly patients, with sustained activity. Elderly patients did not display specific inflammatory or angiogenic circulating profiles.
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Affiliation(s)
- Loïc Mourey
- IUCT-Oncopole Claudius Regaud, Toulouse, France
| | - Larissa Tames Rainho
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | - Lucía Carril-Ajuria
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | | | - Gwenaëlle Gravis
- Institut Paoli-Calmettes, Department of Medical Oncology, Aix Marseille Univ, INSERM, CNRS, CRCM, Immunity and Cancer Team, Marseille, France
| | | | | | | | | | - Marine Gross-Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire Saint-André, Bordeaux, France
| | | | | | | | | | - Nathalie Chaput
- Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Marie Naigeon
- Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Marcus Teixeira
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Bernard Escudier
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Ronan Flippot
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France; Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France; Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France.
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2
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Numakura K, Sekine Y, Hatakeyama S, Muto Y, Sobu R, Kobayashi M, Sasagawa H, Kashima S, Yamamto R, Nara T, Akashi H, Tabata R, Sato S, Saito M, Narita S, Ohyama C, Habuchi T. Primary resistance to nivolumab plus ipilimumab therapy in patients with metastatic renal cell carcinoma. Cancer Med 2023; 12:16837-16845. [PMID: 37403728 PMCID: PMC10501267 DOI: 10.1002/cam4.6306] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Nivolumab plus ipilimumab (NIVO+IPI) is the first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Approximately 40% of patients achieve a durable response; however, 20% develop primary resistant disease (PRD) to NIVO+IPI, about which little is known in patients with mRCC. Therefore, this investigation aimed to evaluate the clinical implication of PRD in patients with mRCC to select better candidates in whom NIVO+IPI can be initiated as first-line therapy. METHODS This multi-institutional retrospective cohort study used data collected between August 2015 and January 2023. In total, 120 patients with mRCC treated with NIVO+IPI were eligible. Associations between immune-related adverse events and progression-free survival, overall survival (OS), and objective response rate were analyzed. The relationship between other clinical factors and outcomes was also evaluated. RESULTS The median observation period was 16 months (interquartile range, 5-27). The median age at NIVO+IPI initiation was 68 years in the male-dominant population (n = 86, 71.7%), and most patients had clear cell histology (n = 104, 86.7%). PRD was recorded in 26 (23.4%) of 111 investigated patients during NIVO+IPI therapy. Patients who experienced PRD showed worse OS (hazard ratio: 4.525, 95% confidence interval [CI]: 2.315-8.850, p < 0.001). Multivariable analysis showed that lymph node metastasis (LNM) (odds ratio: 4.274, 95% CI: 1.075-16.949, p = 0.039) was an independent risk factor for PRD. CONCLUSIONS PRD was strongly correlated with worse survival rates. LNM was independently associated with PRD in patients with mRCC receiving NIVO+IPI as first-line therapy and might indicate that a candidate will not benefit from NIVO+IPI.
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Affiliation(s)
- Kazuyuki Numakura
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Yuya Sekine
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yumina Muto
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Ryuta Sobu
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Mizuki Kobayashi
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Hajime Sasagawa
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Soki Kashima
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Ryohei Yamamto
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Taketoshi Nara
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Hideo Akashi
- Department of AnatomyAkita University Graduate School of MedicineAkitaJapan
| | - Ryuji Tabata
- Department of UrologyAgeo Central General HospitalAgeoJapan
| | - Satoshi Sato
- Department of UrologyAgeo Central General HospitalAgeoJapan
| | - Mitsuru Saito
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Shintaro Narita
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Tomonori Habuchi
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
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3
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Malaty MM, Amarasekera AT, Li C, Scherrer-Crosbie M, Tan TC. Incidence of immune checkpoint inhibitor mediated cardiovascular toxicity: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13831. [PMID: 35788986 DOI: 10.1111/eci.13831] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) are a novel class of anti-cancer therapy becoming increasingly associated with fatal cardiovascular toxicities (CVTs). The aim is to determine the incidence of CVTs in cohorts treated with ICIs as sole anti-cancer therapy. METHODS A systematic literature search of scientific and medical databases was performed using PRISMA principles to identify relevant cohorts (PROSPERO registration CRD42021272470). Data for specific CVTs (pericardial disease, myocarditis, heart failure, arrhythmia, myocardial infarction/ischaemia and angina), CVT-related death and CV risk factors were extracted. Presence of CVTs in ICI-monotherapy versus combination-ICI therapy, and programmed death 1/programmed death ligand 1- (PD1/PDL1-) versus cytotoxic T-lymphocyte-associated protein 4- (CTLA4-) inhibitor groups were dichotomised and meta-analysed using random-effect models. RESULTS Forty-eight studies (11,207 patients) were identified, from which 146 CVTs were observed (incidence 1.30%). ICI-monotherapy led to more CVTs than combination therapy (119/9009; 1.32% vs. 18/2086; 0.86%). Across monotherapies, PD1/PDL1-inhibitors had lower incidence of CVTs compared to CTLA4-inhibitors (62/6950; 0.89% vs. 57/2059; 2.77%). Based on eight studies that were meta-analysed, no significant difference was observed comparing monotherapy versus combination-ICI therapy (RR-0.69, 95% CI -1.47 to 0.09) for all CVTs, or PD1/PDL1- to CTLA4-inhibitors (RR-0.27, 95% CI -2.06 to 1.53), for all CVTs including CVT-death. CV risk factors could not be attributed to an ICI group as data was population based rather than individual based. CONCLUSION ICI-mediated CVTs are rare and potentially fatal. The role of CV risk factors in their development remains unclear.
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Affiliation(s)
- Michael M Malaty
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Anjalee Thanuja Amarasekera
- School of Medicine, Western Sydney University, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia.,Westmead Applied Research Centre (WARC), Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Cindy Li
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
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4
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Kobayashi M, Numakura K, Hatakeyama S, Muto Y, Sekine Y, Sasagawa H, Kashima S, Yamamoto R, Koizumi A, Nara T, Saito M, Narita S, Ohyama C, Habuchi T. Severe Immune-Related Adverse Events in Patients Treated with Nivolumab for Metastatic Renal Cell Carcinoma Are Associated with PDCD1 Polymorphism. Genes (Basel) 2022; 13:genes13071204. [PMID: 35885987 PMCID: PMC9324515 DOI: 10.3390/genes13071204] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Single nucleotide polymorphisms (SNPs) reportedly influence the effect of nivolumab in metastatic renal cell carcinoma (mRCC). This study aimed to evaluate the relationship between the clinical outcomes of patients with mRCC and SNPs in programmed cell death protein 1 (PD-1) protein-coding gene (PDCD1) and explore any potential correlation with patient prognosis and incidence of immune-related adverse events (irAEs). In total, 106 patients with mRCC, who were treated with nivolumab alone (n = 59) or nivolumab and ipilimumab (n = 47), were enrolled in the study. Three SNPs in the PDCD1 gene, namely PD-1.3, PD-1.5, and PD-1.6, were assessed. Patients harboring the PD-1.6 G allele experienced more severe (odds ratio, 3.390; 95% confidence interval 1.517–7.756; p = 0.003) and multiple (OR, 2.778; 95% CI, 1.020–6.993 p = 0.031) irAEs than those harboring the AA genotype. Thus, the existence of the PDCD1 PD-1.6 polymorphism (G allele) was associated with the occurrence of severe and multiple irAEs in patients with mRCC. Further evaluation of PDCD1 polymorphisms might help identify patients experiencing irAE by nivolumab treatment.
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Affiliation(s)
- Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
- Correspondence: ; Tel.: +81-18-884-6460
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8203, Japan; (S.H.); (C.O.)
| | - Yumina Muto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Yuya Sekine
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Hajime Sasagawa
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Soki Kashima
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Ryohei Yamamoto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Atsushi Koizumi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Taketoshi Nara
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8203, Japan; (S.H.); (C.O.)
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
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5
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Rauthan A, Murthy NY, Patil P, Nigade G, Somashekhar SP, Zaveri SS. Real-World Experience with Nivolumab in Metastatic Renal Cell Carcinoma Patients Who Have Progressed on Prior Therapies: A Single-Center Study from India. South Asian J Cancer 2022; 11:133-139. [DOI: 10.1055/s-0041-1740373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction Nivolumab monotherapy is approved for the treatment of metastatic renal cell carcinoma (mRCC) patients who have progressed on prior therapies based on the pivotal Checkmate-025 trial. There is limited literature on the efficacy and safety profile of usage of nivolumab in the treatment of mRCC in India in a real-world setting.
Methods A retrospective analysis was performed of patients who received nivolumab monotherapy for mRCC after having progressed on prior therapies. Tumor response was graded according to RECIST v1.1 and Kaplan–Meier survival analysis was used to estimate progression-free survival (PFS) and overall survival (OS). Immune-related adverse events (irAEs) were documented and graded according to CTCAE v5.0.
Results Between 2016 and 2019, 35 patients received nivolumab for mRCC at our center after progression on prior therapies. A majority of the patients (n = 30, 85.7%) received it in a second-line setting, and the remaining in the third line and beyond setting. Clear cell was the most common histology (n = 26, 74.3%). There were 18 patients (51.42%) who belonged to IMDC intermediate risk, while 17 (48.58%) patients were at poor risk. The overall response rate was 60%, with complete response (CR) in 11.4%. Median duration of response was not reached among responders. Median PFS was 5 months (95% confidence interval [CI]: 3.06–6.93) and median OS was 26 months (95% CI: 1.90–50.09). Ongoing survival of 47, 42, 34, and 22 months was noted in four patients with CR, respectively. In our study, 23 patients (65.71%) experienced any grade of irAE. Grade 3 irAEs was seen in four patients (11.42%). Most common irAE was thyroid dysfunction seen in 12 patients (34.2%). Treatment discontinuation due to irAEs occurred in three patients (8.57%).
Conclusion Nivolumab showed good efficacy with high response rates and an OS comparable to the pivotal Checkmate-025 trial. It was well tolerated with safety profile in terms of irAE consistent with those reported in literature.
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Affiliation(s)
- Amit Rauthan
- Department of Medical Oncology, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - Nitin Yashas Murthy
- Department of Medical Oncology, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - Poonam Patil
- Department of Medical Oncology, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - Gaurav Nigade
- Department of Medical Oncology, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - S P Somashekhar
- Department of Surgical Oncology, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - Shabber S. Zaveri
- Department of Surgical Oncology, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
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6
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Nemoto Y, Ishihara H, Nakamura K, Tachibana H, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Shimmura H, Hashimoto Y, Tanabe K, Kondo T, Takagi T. Efficacy and safety of immune checkpoint inhibitors in elderly patients with metastatic renal cell carcinoma. Int Urol Nephrol 2021; 54:47-54. [PMID: 34704214 DOI: 10.1007/s11255-021-03042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To clarify the efficacy and safety profile of immune checkpoint inhibitors (ICIs) for elderly patients with metastatic renal cell carcinoma (mRCC). METHODS We retrospectively evaluated 149 mRCC patients treated with nivolumab monotherapy as subsequent therapy (n = 89) and nivolumab plus ipilimumab as first-line therapy (n = 60) at 5 affiliated institutions. The patients were divided according to age: > 70 (elderly) vs. ≤ 70 years (young). Efficacy was analyzed by comparing progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR) between elderly and young patients. Safety was assessed by comparing the incidence rates of immune-related adverse events (irAEs). RESULTS In the nivolumab monotherapy group, 34/89 patients (38%) were classified as elderly. There was no significant difference in PFS (p = 0.607), OS (p = 0.383), ORR (p = 0.0699), or DCR (p = 0.881) between elderly and young patients. In the nivolumab plus ipilimumab group, 20/60 patients (33%) were classified as elderly. There was no significant difference in PFS (p = 0.995), OS (p = 0.714), ORR (p = 0.763), or DCR (p = 1.000) between the two groups. The incidence rate of irAEs was not significantly different in the nivolumab (any grade: p = 0.121; grade ≥ 3: p = 0.542) or in the nivolumab plus ipilimumab (any grade: p = 0.666; grade ≥ 3: p = 0.576) group; a higher rate of gastrointestinal irAEs was observed in elderly than in young patients (any grade 15% vs. 3%). CONCLUSIONS The efficacy and safety of nivolumab monotherapy and nivolumab plus ipilimumab were comparable between elderly and young patients. Thus, chronological age alone should not be a contraindication in the use of ICIs for mRCC.
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Affiliation(s)
- Yuki Nemoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama, Japan.,Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Kazutaka Nakamura
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.,Department of Urology, Tokiwakai Jyoban Hospital, 57 Kaminodai, Jyoban Kamiyunagayamachi, Iwaki, Fukushima, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.,Department of Urology, Saiseikai Kurihashi Hospital, 714-6 Koemon, Kuki, Saitama, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Hiroaki Shimmura
- Department of Urology, Tokiwakai Jyoban Hospital, 57 Kaminodai, Jyoban Kamiyunagayamachi, Iwaki, Fukushima, Japan
| | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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7
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Abstract
Aging leads to numerous changes that affect many components of the immune system, called "immunosenescence". Indeed, elderly individuals exhibit dysregulated immune responses against pathogens, poor responses to vaccination, and increased susceptibility to many diseases including cancer, autoimmune disorders, and other chronic inflammatory diseases. Despite progressed understanding of immunosenescence, its detailed mechanisms are still not fully understood. With advances in medicine, the population of older cancer patients is expected to rapidly increase in the coming years. Cancer immunotherapies, including immune checkpoint inhibitors (ICIs), have been shown to be effective for multiple cancer types, whereas to date, few specific data for elderly individuals have been published. Some systemic reviews have demonstrated that ICIs exhibit similar efficacy in older cancer patients, but they seem to be less effective in very old patients. In addition, toxicities might be more frequently observed in such patients. Here, we provide a summary to better understand immunosenescence and an overview of its relationship with cancer and antitumor immunity, including the efficacy and toxicity of ICIs.
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8
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Comparison of nivolumab plus ipilimumab with tyrosine kinase inhibitors as first-line therapies for metastatic renal-cell carcinoma: a multicenter retrospective study. Int J Clin Oncol 2020; 26:154-162. [PMID: 33067647 DOI: 10.1007/s10147-020-01797-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study compared real-world outcomes of metastatic renal-cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors or nivolumab plus ipilimumab. METHODS Using the International mRCC Database Consortium (IMDC), we retrospectively evaluated intermediate- and poor-risk mRCC patients who were treated with nivolumab plus ipilimumab (Nivo-Ipi), tyrosine kinase inhibitors (TKIs) as the first-line therapy between August 2015 and January 2020. We compared oncological outcomes between the Nivo-Ipi group and TKIs group using multivariate logistic regression analysis with the inverse probability of treatment weighting (IPTW) method. RESULTS In this study 278 patients were included. There were 52 and 226 patients in the Nivo-Ipi and TKIs groups (sunitinib 97, axitinib 118, sorafenib 9, pazopanib 2), respectively. The median age in the Nivo-Ipi and TKIs groups were 69 and 67 years, respectively. There was no significant difference in age, performance status, history of nephrectomy, and the IMDC risk group distribution between the groups. The objective response rate was significantly higher in the Nivo-Ipi group (38%) than in the TKIs group (23%, P = 0.018). The IPTW-adjusted Cox regression analysis showed that a significantly longer progression-free survival (hazard ratio 0.60, P = 0.039) and overall survival (hazard ratio 0.51, P = 0.037) rates in the Nivo-Ipi group than those in the TKIs group. CONCLUSIONS The oncological outcomes of patients receiving the first-line therapy of nivolumab plus ipilimumab in real-world practice were significantly improved in comparison with first-line TKIs therapy.
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Tanaka T, Hatakeyama S, Numakura K, Kido K, Noro D, Oikawa M, Hosogoe S, Tokui N, Yamamoto H, Narita S, Ito H, Yoneyama T, Hashimoto Y, Kawaguchi T, Habuchi T, Ohyama C. Efficacy and safety of first‐line nivolumab plus ipilimumab in patients with metastatic renal cell carcinoma: A multicenter retrospective study. Int J Urol 2020; 27:1095-1100. [DOI: 10.1111/iju.14363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Toshikazu Tanaka
- Department of Urology Hirosaki University Graduate School of Medicine HirosakiJapan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy Hirosaki University Graduate School of Medicine HirosakiJapan
| | - Kazuyuki Numakura
- Department of Urology Akita University Graduate School of Medicine AkitaJapan
| | - Koichi Kido
- Department of Urology Hirosaki University Graduate School of Medicine HirosakiJapan
| | - Daisuke Noro
- Department of Urology Mutsu General Hospital MutsuJapan
| | - Masaaki Oikawa
- Department of Urology Hakodate Municipal Hospital HakodateJapan
| | - Shogo Hosogoe
- Department of Urology Aomori City Hospital AomoriJapan
| | - Noriko Tokui
- Department of Urology Odate Municipal Hospital OdateJapan
| | - Hayato Yamamoto
- Department of Urology Hirosaki University Graduate School of Medicine HirosakiJapan
| | - Shintaro Narita
- Department of Urology Akita University Graduate School of Medicine AkitaJapan
| | - Hiroyuki Ito
- Department of Urology Aomori Rosai Hospital HachinoheJapan
| | - Takahiro Yoneyama
- Department of Advanced Transplant Regenerative Medicine Hirosaki University Graduate School of Medicine HirosakiJapan
| | - Yasuhiro Hashimoto
- Department of Urology Hirosaki University Graduate School of Medicine HirosakiJapan
| | | | - Tomonori Habuchi
- Department of Urology Akita University Graduate School of Medicine AkitaJapan
| | - Chikara Ohyama
- Department of Urology Hirosaki University Graduate School of Medicine HirosakiJapan
- Department of Advanced Blood Purification Therapy Hirosaki University Graduate School of Medicine HirosakiJapan
- Department of Advanced Transplant Regenerative Medicine Hirosaki University Graduate School of Medicine HirosakiJapan
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