Assistant Professor of Medicine University of Florida Gainesville, FL, United States
Background: Immune checkpoint inhibitors (ICIs) have revolutionized the care of patients with kidney cancer however many of the clinical trials that have led to the approval of these agents have low enrollments of older patients for whom safety data is limited.
Methods: A retrospective study was performed that collected data on patients aged 65 and older with kidney cancer who were treated at the University of Florida Health Cancer Center between January 2018 and September 2022. Patients must have received at least one dose of an ICI to be included in the study. We collected data on all documented immune related adverse events (irAEs) which were deemed attributable to the ICI by the treating provider.
Results: We identified a total of 58 patients who met the inclusion criteria of our study. The ages of patients ranged from 65 to 92 and the median age was 71. An irAE was documented in 33 patients (57%) while 25 patients (43%) had no documented irAE. Patients were categorized by the highest grade of toxicity experienced. Amongst patients who experienced an irAE, a grade 1 toxicity was found in 5 patients (15%), while a grade 2 toxicity was found in 17 patients (52%), with 10 patients (30%) having a grade 3 toxicity, and 1 patient experiencing a grade 4 toxicity (3%). There were no documented grade 5 toxicities. Amongst all patients, we found that 16 (28%) required either oral or intravenous steroids to manage their irAE. Discontinuation of treatment due to irAE was found in 7 patients (12%) and inpatient hospitalization due to irAE occurred in 7 patients (12%).
Conclusions: Our study demonstrates the real world safety of ICIs in older kidney cancer patients. We show that use of ICIs in this population is generally safe with low rates of serious irAEs, steroid use, hospitalization, and discontinuation rates.
