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Master Thesis

Sécurité et efficacité des immunothérapies de type inhibiteurs de point de contrôle de l’immunité chez les patients de plus de 70 ans atteints de cancers

Abstract : Introduction: checkpoint Inhibitors (CPI) have greatly modified the management of many advanced cancers. There is no specific prospective trial published with these treatments on an elderly population. Methods: this retrospective study focuses on patients over 70 years old treated with CPI (anti-PD- 1, anti PD-L1 anti CTLA-4) between 2014 and 2018 in Bordeaux (CLCC Bergonié or CHU de Bordeaux).The primary objective was to evaluate the prevalence of severe toxicities, defined as toxic death, definitive discontinuation of the treatment for toxicity, hospitalization requirement for the implementation of corticosteroid therapy because of a toxicity, and / or initiation of corticosteroid therapy above 0.7 mg / kg for more than 2 weeks. The secondary objective was to retrieve associations between these severe toxicities, efficacy define by disease response and parameters of interest. Results: 194 patients were included, 139 were men (71.6%) with a median age of 75 years. Twentyfour patients, 12.4% of the total (IC95 7-17%) had serious adverse event. A body mass index below 21 was associated with a higher risk of severe toxicity (HR 2.5 [1.1-5.8] p = 0.03). The objective response rate was 27.8% with no statistically associated parameter.\uDBC0\uDC01 There was an association between response or stabilization and the good performans status (0 or 1) (OR = 0.37 CI95% [0.19-0.73] p = 0.004) and the intake of less than 3 drugs per day (HR = 0.48 CI95% [0.27-0.88] p = 0.02). For 116 patients with bronchial carcinomas, BMI <21 was also associated with overtoxicity (HR 0.283 p = 0.02) and poly-medication was associated with poorer objective response to CPI (p = 0.04). Conclusion: our study shows that CPI treatments can be considered irrespective of patients chronological age. The inclusion of elderly patients in prospective trials and the development of specific oncogeriatric trials should be encouraged.
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Guillaume Goldzak. Sécurité et efficacité des immunothérapies de type inhibiteurs de point de contrôle de l’immunité chez les patients de plus de 70 ans atteints de cancers. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02427121⟩

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