Immune and targeted therapy for cancer: time to rethink restrictions for the treatment of the elderly and frail

ABSTRACT

Targeted and immunotherapy have revolutionized cancer treatment. They safely substitute for traditional chemotherapy in a significant and growing number of malignancies. In this article, we review the United States Food and Drug Administration (FDA) - approved targeted and immunotherapies, currently used in oncology and compare their safety and efficacy in young versus geriatric and frail sub-population. The results suggest an overall comparable, if not superior efficacy in several tumor types, with acceptable toxicities across the board compared to cytotoxic chemotherapy and a favorable analysis in the comparison to the results observed in the younger population. The very decision to place elderly patients on exclusive palliative care can no longer be supported based on age or frailty alone. The historical concept of medical oncologists leaning for palliative treatments for these patients needs to be revisited.

RESUMO

A imunoterapia direcionada revolucionou o tratamento do câncer. Eles substituem com segurança a quimioterapia tradicional em um número significativo e crescente de doenças malignas. Neste artigo, revisamos a Food and Drug Administration (FDA) - imunoterapias direcionadas aprovadas atualmente usadas em oncologia, e comparamos sua segurança e eficácia na subpopulação jovem versus geriátrica e frágil. Com resultados sugerindo uma eficácia geral comparável, se não superior, em vários tipos de tumor com toxicidades aceitáveis em toda a linha em comparação com a quimioterapia citotóxica, e uma análise favorável na comparação com os resultados observados na população mais jovem. A própria decisão de colocar pacientes idosos em cuidados paliativos exclusivos não pode mais ser sustentada apenas com base na idade ou fragilidade. O conceito histórico de médicos oncologistas que buscam tratamentos paliativos para esses pacientes precisa ser revisitado.

Keywords:

Molecular targeted therapy - Immunotherapy - Therapeutics - Frail elderly - Aged.

Descritores:

Terapia de alvo molecular - Imunoterapia - Terapêutica - Idoso frágil - Envelhecido.

CONFLICT OF INTEREST STATEMENT

The authors listed below certify that they have no involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships and affiliations) in the subject matter discussed in this manuscript.

Juliana Beal

Nothing to disclose.

Gustavo Schvartsman

Participation in speakers' bureaus: Bristol-Myers Squibb, Novartis, Merck Sharp and Dohme, Sanofi, AstraZeneca, Roche, Amgen. Consultancies: AstraZeneca, Roche, Merck Sharp and Dohme.

Rodrigo Munhoz

Honoraria: Bayer, BMS, Novartis, Merck-Serono, MSD, Roche, Sanofi. Participation in speakers' bureaus: BMS, Novartis, Merck-Serono, MSD, Roche, Sanofi. Consultancies: Bayer, Merck-Serono, Roche, Sanofi.

Theodora Karnakis Nothing to disclose.

Rafael Kaliks

Participation in speakers' bureaus: Astra Zeneca; Novartis; Pfizer; Roche. Consultancies: Astra Zeneca.

Publication History

Received: 10 March 2021

Accepted: 29 March 2021

Article published online:
18 July 2021

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