Background: Prior to the introduction of immunotherapy, geriatric patients were often considered unsuitable for systemic anti-cancer therapies based on evaluations using traditional assessment tools including the Eastern Cooperative Oncology Group (ECOG) score, Charlson Comorbidity Index (CCI) and the Cancer and Aging Research Group (CARG) score. The advent of immunotherapy has transformed the landscape of medical oncology, where for some malignancies it offers equal or superior efficacy and improved tolerability compared to traditional chemotherapy regimens. Furthermore, it has allowed for the option of systemic therapy in the setting of metastatic melanoma and non-melanoma skin cancers. Considering the geriatric population’s significant representation among those with advanced skin cancers, the tolerability of immunotherapy is of particular interest within this groups.
Aim: Assess the tolerance of immunotherapy in two geriatric patients who, based on traditional assessment tools, would have been considered unsuitable for systemic therapy.
Methods: This study presents a case series of two octogenerian patients, aged between 80-89 years old, who received Cemiplimab immunotherapy to manage metastatic cutaneous squamous cell carcinoma. Demographics, comorbidities, baseline geriatric assessments, experienced toxicities and oncological outcomes were accessed through the cancer care health information system MOSAIQ.
Results: The first patient, an 85-year-old male with an ECOG score of 2, CCI score of 14 points and CARG score of 12 points, completed 35 cycles of Cemiplimab with the most severe toxicity being grade 2 fatigue. The second patient, an 89-year-old male with an ECOG score of 1, CCI score of 14 points and CARG score of 6 points, completed 24 cycles of Cemiplimab and experienced only grade 1 toxicities. Both patients achieved an excellent oncological response to immunotherapy. Conclusion: This case series of two octogenerian patients demonstrates that immunotherapy was well tolerated. It suggests that traditional assessment tools may not adequately assess the suitability of immunotherapy for this population.