Older Adults May Experience Equal Benefit From Cancer Immunotherapies as Younger Patients

Study suggests potentially expanding the use of immunotherapies in the elderly, a population in whom these therapies may be under-prescribed.

Elderly patients with cancer may benefit as much as younger patients from immunotherapies, according to a study published in Cell Reports. The investigators said the results suggest potentially expanding the use of these therapies in the elderly, a population in whom immunotherapies may be under-prescribed.

“The interaction between age, immunity, and cancers has been understudied, particularly with the rise of cancer immunotherapies,” said Rossin Erbe, a PhD candidate at the Johns Hopkins University School of Medicine, in a press release.

According to the investigators, aging simultaneously increases cancer incidence and lowers general immunity, with older patients becoming less capable of mounting an effective immune response to disease. As a result, immunotherapies are less frequently prescribed to older adults, despite some clinical trials suggesting that elderly cancer patients have equal or better responses to immunotherapies compared to younger patients.

To conduct the study, the investigators collected genomics and clinical data obtained from tumors and healthy tissues stored in several databases, including the Cancer Genome Atlas, the Genomics Evidence Neoplasia Information Exchange, a database run by Caris Life Sciences, the Molecular Taxonomy of Breast Cancer, and the Genotype-Tissue Expression project. In total, they reviewed data from 77,732 patients with 31 different cancer types.

According to the results of the study, aging is associated with multiple factors known to correlate with increased response to immunotherapies. These include an increase in the number of mutations in tumor cells, increased expression of immune checkpoint proteins, and increased interferon gamma signaling. However, it is also associated with factors that could decrease immune response, including a lack of diversity of T cell receptors and a greater population of macrophages, specifically in some breast cancers.

“Characteristics of tumors from older patients certainly have biological properties consistent with a robust immune response,” said Elana Fertig, PhD, in the release. “We think this is something that deserves more study using tumor atlases with prospective study designs that are tailored to study aging and immunotherapy response.”

The investigators said these data suggest biomarkers for immunotherapies could still be used as a basis to select immunotherapy treatment in older patients. However, they also add that multiple factors beyond biomarkers should be taken into account, including frailty and health conditions that could affect the patients’ response and ability to manage adverse effects.

REFERENCE

Older patients benefit from cancer immunotherapies [news release]. EurekAlert; September 7, 2021. Accessed September 8, 2021. https://www.eurekalert.org/news-releases/927646