Tolerance to First-Line Immunotherapy in Elderly Patients with Advanced Solid Tumours

Angelina Towadros, Sandra Boles, Salman Anwar and Dalia Kamel*

Aim of the study: This review examines how ageing-related changes in the immune system impact the response to immunotherapy and assesses the potential challenges to treatment tolerance in elderly patients.

Methodology: This is a retrospective study of patients with advanced solid cancer treated at Blackrock and St Vincent Private Hospital with immunotherapy as first line in elderly patients. An electronic database search identified patients treated with monotherapy between March 2024 and February 2025. We collected demographics, treatment details, baseline laboratory investigations, adverse events and the outcome of disease for each patient. Data were analysed to determine associations between therapy, clinical characteristics, and baseline laboratory investigations related to disease outcome using the chi-square test and independent samples t-tests.

Results: We identified 17 elderly patients with advanced solid cancers who received immunotherapy as first-line systemic treatment. The mean age of the cohort was 77 ± 11 years, with 12 (70%) males. In terms of Eastern Cooperative Oncology Group (ECOG) performance status, 4 (24%) had an ECOG score of 0, 7 (41%) had an ECOG score of 1, and 6 (35%) had an ECOG score of 2. Additionally, 13 (76%) of the patients had pre-existing comorbidities. The cancer types included 6 (36%) head and neck cancer, 4 (24%) malignant melanoma, 4 (24%) renal cell carcinoma, 2 (11%) lung cancers, and 1 (5%) colon cancer. Radical surgery was offered to 6 (35%) patients, radical radiotherapy to 7 (41%), and concomitant chemotherapy to 4 (24%). The mean duration of immunotherapy was 65 weeks (ranging from 5 to 292 weeks). Among the patients, 11 (64%) experienced autoimmune side effects, with 3 (17%) reporting more than one side effect. The most common adverse effects included fatigue in 6 (35%), skin rash of grades 1-2 in 3 (17%), hypothyroidism in 3 (17%), diarrhoea in 3 (17%), and arthralgia in 1 (5%). The severity of side effects was classified as grade 1 in 6 (35%) patients, grade 2 in 9 (52%), and grade 3 in 1 (5%). Four patients (24%) discontinued immunotherapy, with 3 (17%) due to disease progression and 1 (5%) due to toxicity. Notably, there was no significant difference in demographics, treatment modalities or laboratory findings between patients who experienced adverse events and those who did not.

Keywords:

Published on: Dec 3, 2025 Pages: 4-7

Full Text PDF Full Text HTML DOI: 10.17352/ijocs.000066
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