A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer
Abstract Background This study was designed to investigate the impact of age on the effectiveness and immune-related adverse events (irAEs) of programmed death-(ligand)1 [PD-(L)1] inhibitors in patients with non-small cell lung cancer (NSCLC) using a novel text-mining technique. Methods This retrosp...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-023-10701-z |
| _version_ | 1797864429440729088 |
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| author | Hanieh Abedian Kalkhoran Juliëtte Zwaveling Bert N. Storm Sylvia A. van Laar Johanneke EA Portielje Henk Codrington Dieuwke Luijten Pepijn Brocken Egbert F. Smit Loes E. Visser |
| author_facet | Hanieh Abedian Kalkhoran Juliëtte Zwaveling Bert N. Storm Sylvia A. van Laar Johanneke EA Portielje Henk Codrington Dieuwke Luijten Pepijn Brocken Egbert F. Smit Loes E. Visser |
| author_sort | Hanieh Abedian Kalkhoran |
| collection | DOAJ |
| description | Abstract Background This study was designed to investigate the impact of age on the effectiveness and immune-related adverse events (irAEs) of programmed death-(ligand)1 [PD-(L)1] inhibitors in patients with non-small cell lung cancer (NSCLC) using a novel text-mining technique. Methods This retrospective study included patients with stage III/IV NSCLC treated with a PD-(L)1 inhibitor (nivolumab, pembrolizumab, atezolizumab and durvalumab) at Leiden University Medical Centre and Haga Teaching hospital, (both in The Netherlands) from September 2016 to May 2021. All the relevant data was extracted from the structured and unstructured fields of the Electronic Health Records using a novel text-mining tool. Effectiveness [progression-free survival (PFS) and overall survival (OS)] and safety (the incidence of nine potentially fatal irAEs and systemic corticosteroid requirement) outcomes were compared across age subgroups (young: < 65 years, Middle-aged: 65–74 years, and old: ≥ 75 years) after adjustment for confounding. Results Of 689 patients, 310 patients (45.0%) were < 65 years, 275 patients (39.9%) were aged between 65 and 74 years, and 104 patients (15.1%) were ≥ 75 years. There was no significant difference between younger and older patients regarding PFS (median PFS 12, 8, 13 months respectively; Hazard ratio (HR)middle-aged = 1.14, 95% CI 0.92–1.41; HRold = 1.10, 95% CI 0.78–1.42). This was also the case for OS (median OS 19, 14, 18 months respectively; HRmiddle-aged = 1.22, 95% CI 0.96–1.53; HRold = 1.10, 95% CI 0.79–1.52). Safety analysis demonstrated a higher incidence of pneumonitis among patients aged 65–74. When all the investigated irAEs were pooled, there was no statistically significant difference found between age and the incidence of potentially fatal irAEs. Conclusions The use of PD-(L)1 inhibitors is not associated with age related decrease of PFS and OS, nor with increased incidence of serious irAEs compared to younger patients receiving these treatments. Chronological age must therefore not be used as a predictor for the effectiveness or safety of ICIs. |
| first_indexed | 2024-04-09T22:52:53Z |
| format | Article |
| id | doaj.art-6e2c3adabad54791a0cd2e967e1b62e7 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-09T22:52:53Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-6e2c3adabad54791a0cd2e967e1b62e72023-03-22T11:34:12ZengBMCBMC Cancer1471-24072023-03-0123111210.1186/s12885-023-10701-zA text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancerHanieh Abedian Kalkhoran0Juliëtte Zwaveling1Bert N. Storm2Sylvia A. van Laar3Johanneke EA Portielje4Henk Codrington5Dieuwke Luijten6Pepijn Brocken7Egbert F. Smit8Loes E. Visser9Department of Clinical Pharmacy and Toxicology, Leiden University Medical CentreDepartment of Clinical Pharmacy and Toxicology, Leiden University Medical CentreDepartment of Pharmacy, Haga Teaching HospitalDepartment of Clinical Pharmacy and Toxicology, Leiden University Medical CentreDepartment of Internal Medicine – Medical Oncology, Leiden University Medical CentreDepartment of Pulmonary Diseases – Pulmonic Oncology, Haga Teaching HospitalDepartment of Pulmonary Diseases – Pulmonic Oncology, Haga Teaching HospitalDepartment of Pulmonary Diseases – Pulmonic Oncology, Haga Teaching HospitalDepartment of Pulmonary Disease, Leiden University Medical CentreDepartment of Pharmacy, Haga Teaching HospitalAbstract Background This study was designed to investigate the impact of age on the effectiveness and immune-related adverse events (irAEs) of programmed death-(ligand)1 [PD-(L)1] inhibitors in patients with non-small cell lung cancer (NSCLC) using a novel text-mining technique. Methods This retrospective study included patients with stage III/IV NSCLC treated with a PD-(L)1 inhibitor (nivolumab, pembrolizumab, atezolizumab and durvalumab) at Leiden University Medical Centre and Haga Teaching hospital, (both in The Netherlands) from September 2016 to May 2021. All the relevant data was extracted from the structured and unstructured fields of the Electronic Health Records using a novel text-mining tool. Effectiveness [progression-free survival (PFS) and overall survival (OS)] and safety (the incidence of nine potentially fatal irAEs and systemic corticosteroid requirement) outcomes were compared across age subgroups (young: < 65 years, Middle-aged: 65–74 years, and old: ≥ 75 years) after adjustment for confounding. Results Of 689 patients, 310 patients (45.0%) were < 65 years, 275 patients (39.9%) were aged between 65 and 74 years, and 104 patients (15.1%) were ≥ 75 years. There was no significant difference between younger and older patients regarding PFS (median PFS 12, 8, 13 months respectively; Hazard ratio (HR)middle-aged = 1.14, 95% CI 0.92–1.41; HRold = 1.10, 95% CI 0.78–1.42). This was also the case for OS (median OS 19, 14, 18 months respectively; HRmiddle-aged = 1.22, 95% CI 0.96–1.53; HRold = 1.10, 95% CI 0.79–1.52). Safety analysis demonstrated a higher incidence of pneumonitis among patients aged 65–74. When all the investigated irAEs were pooled, there was no statistically significant difference found between age and the incidence of potentially fatal irAEs. Conclusions The use of PD-(L)1 inhibitors is not associated with age related decrease of PFS and OS, nor with increased incidence of serious irAEs compared to younger patients receiving these treatments. Chronological age must therefore not be used as a predictor for the effectiveness or safety of ICIs.https://doi.org/10.1186/s12885-023-10701-zNon-small cell lung cancer (NSCLC)Immune checkpoint inhibitor (ICI)Anti-PD-(L)1 therapyReal-worldElderly |
| spellingShingle | Hanieh Abedian Kalkhoran Juliëtte Zwaveling Bert N. Storm Sylvia A. van Laar Johanneke EA Portielje Henk Codrington Dieuwke Luijten Pepijn Brocken Egbert F. Smit Loes E. Visser A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer BMC Cancer Non-small cell lung cancer (NSCLC) Immune checkpoint inhibitor (ICI) Anti-PD-(L)1 therapy Real-world Elderly |
| title | A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer |
| title_full | A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer |
| title_fullStr | A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer |
| title_full_unstemmed | A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer |
| title_short | A text-mining approach to study the real-world effectiveness and potentially fatal immune-related adverse events of PD-1 and PD-L1 inhibitors in older patients with stage III/IV non-small cell lung cancer |
| title_sort | text mining approach to study the real world effectiveness and potentially fatal immune related adverse events of pd 1 and pd l1 inhibitors in older patients with stage iii iv non small cell lung cancer |
| topic | Non-small cell lung cancer (NSCLC) Immune checkpoint inhibitor (ICI) Anti-PD-(L)1 therapy Real-world Elderly |
| url | https://doi.org/10.1186/s12885-023-10701-z |
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