Efficacy of immune checkpoint inhibitors in older adults with advanced stage cancers: a meta-analysis

Lawrence Kasherman, Derrick Ho Wai Siu, Kirsty Wai Chung Lee, Sally Lord, Ian Marschner, Craig R. Lewis, Michael Friedlander, Chee Khoon Lee*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    19 Citations (Scopus)


    Objectives: There is uncertainty whether older patients derive a similar benefit from immune checkpoint inhibitors (ICI) as younger patients. We performed a meta-analysis of ICI trials in advanced cancers to better estimate treatment benefit in the older population.

    Materials and Methods: We performed an electronic search for randomized trials of ICI, either as monotherapy or in combination with other agents. Hazard ratios (HR) for subgroups defined by different age cut-offs were extracted. Pooled overall survival (OS) treatment estimates were calculated using the inverse variance weighted method.

    Results: In nineteen trials comparing ICI monotherapy versus non-ICI treatment, there was no significant treatment–age interaction (age ≥ 65 years: N = 6064, HR 0.73; age < 65 years: N = 7250, HR 0.79; P-interaction = 0.27). Findings were similar at older age cut-offs of 70 years (age ≥ 70 years: N = 433, HR = 0.93; age < 70 years: N = 169, HR = 0.95; P-interaction = 0.91) and 75 years (age ≥ 75 years: N = 139, HR = 0.75; age < 75 years: N = 1133, HR = 0.61; P-interaction = 0.72) respectively, and for trials of ICI combination therapy.

    Conclusion: ICI therapy improves OS in both younger and older patients with advanced cancers, and the magnitude of improvement does not depend on age. Patient selection for ICI therapy should be done based on performance status and adequate organ function independently of age.

    Original languageEnglish
    Pages (from-to)508-514
    Number of pages7
    JournalJournal of Geriatric Oncology
    Issue number3
    Early online date23 May 2019
    Publication statusPublished - Apr 2020


    • Immunotherapy
    • Advanced cancers
    • Older patients
    • Meta-analysis
    • Treatment efficacy


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