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Frailty and checkpoint inhibitor toxicity in older patients with melanoma
Author(s) -
Bruijnen Cheryl P.,
Koldenhof José J.,
Verheijden Rik J.,
Bos Frederiek,
EmmelotVonk Mariëlle H.,
Witteveen Petronella O.,
Suijkerbuijk Karijn P. M.
Publication year - 2022
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.34230
Subject(s) - medicine , discontinuation , adverse effect , observational study , prospective cohort study , pediatrics
Background Immune checkpoint inhibitors (ICIs) can cause immune‐related adverse events (irAEs) that range from mild to life‐threatening. Age itself does not seem to be a predictor for the occurrence of irAEs. It is unknown whether frailty plays a role in the occurrence of irAEs. Therefore, the authors assessed whether irAEs and their sequelae occur more often in frail patients than in fit patients according to the Geriatric 8 (G8) assessment. Methods Patients with melanoma aged 70 years and older who were about to start ICI therapy and were screened with the G8 assessment were enrolled in this prospective, observational study. Patients were classified by the G8 as either fit or frail. The primary outcome was the occurrence of grade ≥3 irAEs. Results In total, 92 patients were included for statistical analyses, 26 (29%) of whom were classified as frail. Grade ≥3 irAEs occurred in 20% of patients. There was no significant difference in the occurrence of grade ≥3 irAEs between fit and frail patients (17% vs 27%; P = .26). Frail patients were admitted to the hospital because of irAEs significantly more often than fit patients (29% vs 54%; P = .02) and showed a trend toward increased length of hospitalization (5 vs 8 days; P = .06) and more frequent use of immunosuppressants or ICI discontinuation for irAEs (36% vs 58%; P = .06). Conclusions Although frailty appears to be unrelated to the occurrence of severe irAEs, it is an indicator of irAE‐related adverse sequelae, such as hospital admission. Screening for frailty can be of added value in the shared decision‐making process for older patients who qualify for ICI treatment.