Dr. Jahanzeb on Immunotherapy in Elderly Patients With NSCLC

Mohammad Jahanzeb, MD
Published: Thursday, Feb 28, 2019



Mohammad Jahanzeb, MD, professor of clinical medicine, Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, discusses immunotherapy in the treatment of elderly patients with non–small cell lung cancer (NSCLC).

There are several factors that limit inclusion to immunotherapy clinical trials in NSCLC, and age is a moving target, Jahanzeb says. There had been a time when investigators seemed to agree that 65 years of age was the cut-off between elderly and nonelderly, probably because it corresponds with the Medicare eligibility age. However, the cut-off has recently become more unclear as some studies have included patients up to 70 years.

Interestingly, when you look at patients older than 65, efficacy with immunotherapy seems to be better, Jahanzeb says. This could be due in large part to the fact that most patients with lung cancer are considered elderly—the median age of those with the disease is 68-years-old. In the CheckMate 017 study presented by Julie R. Brahmer, MD, of Johns Hopkins Medicine, the subset of patients with squamous histology between the ages of 65 and 75 seemed to derive benefit from checkpoint inhibition. However, there appeared to be a detrimental effect with immunotherapy in the patients older than 75 years.
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Mohammad Jahanzeb, MD, professor of clinical medicine, Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, discusses immunotherapy in the treatment of elderly patients with non–small cell lung cancer (NSCLC).

There are several factors that limit inclusion to immunotherapy clinical trials in NSCLC, and age is a moving target, Jahanzeb says. There had been a time when investigators seemed to agree that 65 years of age was the cut-off between elderly and nonelderly, probably because it corresponds with the Medicare eligibility age. However, the cut-off has recently become more unclear as some studies have included patients up to 70 years.

Interestingly, when you look at patients older than 65, efficacy with immunotherapy seems to be better, Jahanzeb says. This could be due in large part to the fact that most patients with lung cancer are considered elderly—the median age of those with the disease is 68-years-old. In the CheckMate 017 study presented by Julie R. Brahmer, MD, of Johns Hopkins Medicine, the subset of patients with squamous histology between the ages of 65 and 75 seemed to derive benefit from checkpoint inhibition. However, there appeared to be a detrimental effect with immunotherapy in the patients older than 75 years.

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