Efficacy of PD-1 & PD-L1 inhibitors in older adults: a meta-analysis
Open accessAbstract
BACKGROUND: Immune checkpoint inhibitors targeting PD-1/PD-L1 pathway demonstrated promising activities in variety of malignancies, however little is known regarding their efficacy in adults aged ≥65 years. METHODS: We conducted a systematic review and a study-level meta-analysis to explore efficacy of ICIs based on age, younger vs older than 65 years. We included in this analysis randomized controlled phase II or III studies in patients with metastatic solid tumors that compared efficacy of PD-1 or PD-L1 inhibitors to a non-PD-1/PD-L1 inhibitor. Aggregated estimates of overall survival (OS) and progression-free survival (PFS) are based on random/mixed effects (RE) models to allow for heterogeneity between the studies. RESULTS: Initial search identified 53 articles, 17 were randomized controlled trials that compared nivolumab, pembrolizumab or atezolizumab to chemotherapy or targeted therapy. Only 9 trials reported hazard ratiios (HR) for OS based on age and were included in this meta-analysis. Out of those studies seven reported HR for PFS but only 4 studies included subgroup-analysis based on age for PFS. The overall estimated random-effects HR for death was 0.64 with 95% CI of 0.54-0.76 in patients ≥65 years vs. 0.68 with 95% CI of 0.61-0.75 in patients < 65 years. The overall estimated random-effects for HR for progression was 0.74 with 95% CI of 0.60-0.92 in patients ≥65 years vs. 0.73 with 95% CI of 0.61-0.88 in patients < 65 years. CONCLUSIONS: PD-1 (nivolumab and pembrolizumab) and PD-L1 (atezolizumab) inhibitors had comparable efficacy in adults younger vs ≥ 65 years.
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Anti-PD-1 drugs are effective for both young and elderly patients.
“A meta-analysis of randomized trials showed that although anti-PD-1 drugs are effective for both young and elderly patients, the risk of death among elderly patients is comparable or improved compared to that of patients subjected to control interventions, with no increased toxicity [155–158].”
From Immunosenescence: a key player in cancer development (2020) · cites this paper as [155]
The risk of death among elderly patients receiving anti-PD-1 drugs is comparable or improved compared to control interventions.
“the risk of death among elderly patients is comparable or improved compared to that of patients subjected to control interventions, with no increased toxicity [155–158].”
From Immunosenescence: a key player in cancer development (2020) · cites this paper as [155]
Anti-PD-1 drugs cause no increased toxicity in elderly patients.
“with no increased toxicity [155–158].”
From Immunosenescence: a key player in cancer development (2020) · cites this paper as [155]
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- Authors
- Elias, R., Giobbie-Hurder, A., McCleary, N. J., Ott, P., Hodi, F. S., & Rahma, O.
- Affiliations
- Boston University (US)
- Harvard University (US)
- Corresponding author
- Rahma, Osama
- Venue
- Journal for ImmunoTherapy of Cancer
- Publisher
- BMJ
- Published
- 2018-04-04
- Volume
- 6
- Issue
- 1
- Pages
- 26-26
- ISSN
- 2051-1426 (ISSN-L)
- PMC
- PMC5885356
- OpenAlex
- W2796929908
- Cited by
- 218
- References
- 34
- Citations by year
- 2026: 15 · 2025: 26 · 2024: 24 · 2023: 26 · 2022: 33 · 2021: 30 · 2020: 28 · 2019: 25 · 2018: 11
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal for ImmunoTherapy of Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Ferroptosis and cancer prognosis
- Keywords
- PD-1 inhibitors, PD-L1 inhibitors, immune checkpoint inhibitors, older adults, age as prognostic factor, nivolumab, pembrolizumab, atezolizumab, metastatic solid tumors, overall survival, progression-free survival, immunotherapy efficacy
- MeSH terms
- Antineoplastic Agents, Immunological, Aged, Humans, Neoplasms, Randomized Controlled Trials as Topic, Treatment Outcome, Clinical Trials, Phase II as Topic, Clinical Trials, Phase III as Topic, B7-H1 Antigen, Programmed Cell Death 1 Receptor
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