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LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 584-585

Are the elderly from India different from the rest of the world? Data in patients with cancer on immunotherapy


Department of Medical Oncology, H.O.P.E. Oncology Clinic, PSRI Hospital, New Delhi, India

Date of Submission20-Aug-2021
Date of Decision21-Aug-2021
Date of Acceptance07-Sep-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Amish D Vora
Department of Medical Oncology, H.O.P.E. Oncology Clinic, PSRI Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_198_21

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How to cite this article:
Vora AD. Are the elderly from India different from the rest of the world? Data in patients with cancer on immunotherapy. Cancer Res Stat Treat 2021;4:584-5

How to cite this URL:
Vora AD. Are the elderly from India different from the rest of the world? Data in patients with cancer on immunotherapy. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:584-5. Available from: https://www.crstonline.com/text.asp?2021/4/3/584/327785



We congratulate Abraham et al. from the Tata Memorial Hospital (TMH), Mumbai, India, for publishing data from one of the largest series on immune checkpoint inhibitors (ICIs) in geriatric patients (more than 60 years) from India.[1] In the same issue of the journal, there is also an editorial by Arora et al. from the All India Institute of Medical Sciences, New Delhi, India, highlighting the need for original data from India regarding ICI use in the elderly population.[2]

We would like to highlight a few points from the article and the editorial:

  1. Under-representation of the geriatric population in clinical trials: Things are changing. In the Javelin 100 trial of maintenance avelumab in patients with metastatic bladder cancer, the median age of patients enrolled in the study was 68-70 years.[3] Even in earlier studies of ICI in non-small cell lung cancer (NSCLC), like KEYNOTE-024, the median age at enrolment was 64 years (which is the geriatric age group, i.e. more than 60 years, as per the definition used in the study by Abraham et al.).[4] This is encouraging and we can no longer say that geriatric patients are under-represented in trials of ICI
  2. Close to 80% of patients in the study by Abraham et al. received nivolumab. This is in contrast to the rest of the world, where the administration of pembrolizumab and nivolumab is relatively well-matched in various indications such as NSCLC and advanced head-and-neck squamous cell carcinoma. Nivolumab was probably used more in the study because of earlier availability and the availability of a patient assistance program in India. It would be interesting to compare the efficacy and the occurrence of immune-related adverse events in older patients with cancer treated with various ICIs
  3. We would request the authors to provide some more information regarding the following points:


    1. Patients who develop a complete remission (CR) following the use of ICIs do extremely well compared to others, for example, in the CheckMate 214 study, 10% of the patients in the combination ICI arm (nivolumab + ipilimumab) achieved a CR and 90% of them had not relapsed at the last follow-up date.[5] Similar information from the Indian population should be compared with international data as 8% of the patients achieved a CR in the study by Abraham et al.
    2. In the meta-analysis by Landre et al. in 900 patients who were over the age of 75 years and had received ICI, either in the first or second line setting, there was no overall survival advantage seen as compared to the younger population.[6] Since 24% of patients in the study by Abraham et al. were over 70 years of age, it would be interesting to evaluate this in the current study as well.
    3. Pseudoprogression was seen in only one patient (0.6%) as compared to 6%–8% in other published data. The reason for this is difficult to understand. It would be interesting if the authors could clarify the reason.


Finally, I would again like to congratulate Abraham and the team from TMH for being pioneers in yet another often neglected specialty of geriatric oncology and presenting the data of ICI use in these patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abraham G, Jobanputra KN, Noronha V, Patil VM, Menon NS, Gattani SC, et al. Immune checkpoint inhibitors in older patients with solid tumors: Real-world experience from India. Cancer Res Stat Treat 2021;4:270-6.  Back to cited text no. 1
  [Full text]  
2.
Arora S, Kumar L. Immune checkpoint inhibitors in older patients with cancer: A new era in cancer therapy. Cancer Res Stat Treat 2021;4:368-9.  Back to cited text no. 2
  [Full text]  
3.
Powles T, Park SH, Voog E, Caserta C, Valderrama BP, Gurney H, et al. Avelumab maintenance therapy for advanced or metastatic urothelial carcinoma. N Engl J Med 2020;383:1218-30.  Back to cited text no. 3
    
4.
Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, et al. Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer. N Engl J Med 2016;375:1823-33.  Back to cited text no. 4
    
5.
Motzer RJ, Tannir NM, McDermott DF, Arén Frontera O, Hammers HJ, Carducci MA, et al. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med 2018;378:1277-90.  Back to cited text no. 5
    
6.
Landre T, Des Guetz G, Chouahnia K, Fossey-Diaz V, Culine S. Immune checkpoint inhibitors for patients aged ≥ 75 years with advanced cancer in first-and second-line settings: A meta-analysis. Drugs Aging 2020;37:747-54.  Back to cited text no. 6
    




 

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