The co-primary objectives will be to assess the safety and quality of life under treatment.
The co-primary objectives will be to assess the safety and quality of life under treatment. Secondary objectives will be evaluations of geriatric data modifications under treatment, efficacy (progression-free survival and overall survival), correlation between toxicity and efficacy, and comparison of the safety profiles between various immunotherapy regimens. Another secondary objective will be the comparison between patients and clinicians symptom reporting. The investigators will also perform a pharmacokinetics analysis on PD1-monoclonal antibodies to improve the understanding of PD-1 inhibitors pharmacokinetics for the elderly population. Finally, toxicity and efficacy will be compared to immunological parameters such as the description of tumor infiltrating lymphocytes, markers of immunosenescence and inflammation.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
All patients included in this study will receive approved immune-checkpoint inhibitors therapies, such as CTLA-4, PD-1, and PD-L1 inhibitors.
Assistance Publique des Hôpitaux de Marseille
Marseille, Bouches Du Rhône, France
Institut Paoli-Calmettes
Marseille, Bouches-du Rhône, France
Institut BERGONIE
Bordeaux, France
CENTRE Francois Baclesse
Caen, France
Number of participants adverse events as assessed by CTCAE v5.0
Description of adverse events' type, incidence, severity (CTCAE v.5.0), timing, seriousness, and relatedness. This endpoint will be based on the rate of grade ≥ 3 adverse events 18 weeks after treatment initiation, defined as medical assessment of safety including adverse events' type, incidence, severity (graded by the CTCAE\] v. 5.0), timing, seriousness, and relatedness. This will include clinical as well as biological toxicities such as liver and endocrine dysfunctions. All high grade adverse events will be taken into account.
Time frame: From treatment initiation to 18 weeks after treatment initiation. (up to 24 months)
European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and Elderly Cancer Patients module (QLQ - ELD14), combined to compute a total score (between 44 and 128 points)
Quality of life will be evaluated using the EORTC QLQ-C30 and QLQ-ELD14 questionnaires collected at inclusion and at every treatment cycles during the first 6 weeks, then every 6 weeks until treatment discontinuation. The proportion of patients with a decrease superior or equal to 10% for their global score between baseline and at 24 weeks after treatment initiation will be estimated.
Time frame: From inclusion until 24 weeks after treatment initiation (up to 24 months)
geriatric data modifications under treatment
Geriatric data assessment will be done at inclusion and every 6 weeks until treatment discontinuation. Exhaustive data will be collected at inclusion. The investigators will also assess the G-CODE (Geriatric Core Dataset), a recently described minimum geriatric data set (see SOFOG guidelines). G-CODE assessment will be repeated every 6 weeks during treatment and at treatment discontinuation. These data will be collected either by the geriatrician or trained clinical research nurses during geriatric consultation as part of geriatric follow-up, an integral part of the patient management.
Time frame: From inclusion until treatment discontinuation (up to 24 months)
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Centre Georges François Leclerc
Dijon, France
Institut Du Cancer de Montpellier
Montpellier, France
Institut Curie
Paris, France
Institut De Cancérologie de l'Ouest
Saint-Herblain, France
IUCT-Oncopole Institut Claudius Rigaud
Toulouse, France
compare patients and clinician symptoms reporting
Reminder of CTCAE version 5.0 will be completed by clinicians before every treatment cycle. Patients will also complete a language adapted version of patient-reported outcome PRO-CTCAE questionnaire. For all symptoms, the investigators will measure the proportion of pairs for which clinicians and patients gave an identical grade. The investigators will also measure the proportion of pairs that will disagree for each symptom by one point (e.g., patient grade 2 and clinician grade 1), and the proportion that will disagree by two or more points (e.g., patient grade 2 and clinician grade 4). The investigators will also record the number of symptoms for which each pair agreed.
Time frame: From treatment initiation to 18 weeks after treatment initiation.(up to 24 months)
Progression-free survival
Evaluation of Progression-free Survival (PFS) will be defined as the time from treatment beginning to radiological (according to the RECIST 1.1 criteria) or clinical progression of the disease as declared by the investigators, or death of any cause. Radiological evaluations will be performed every 6 weeks.
Time frame: time from treatment beginning to radiological or clinical progression of the disease, or death of any cause. (up to 24 months)
Overall Survival
Overall Survival (OS) will be defined as the time from treatment beginning to death of any cause.
Time frame: time from treatment beginning to death of any cause (up to 24 months)
correlation between toxicity and efficacy
Correlation between occurrence of auto-immune adverse events (with a landmark time at week 18) and efficacy (PFS).
Time frame: time from treatment beginning to radiological or clinical progression of the disease, or death of any cause. (up to 24 months)
rate of grade 3 to 5 adverse events 18 weeks after treatment initiation
Safety profiles comparison according to treatment regimen (PD1-inhibitor monotherapy vs PD1- inhibitor/CTLA4-inhibitor combination vs CTLA-inhibitor monotherapy vs PDL1-inhibitor if available at time of trial beginning) will be performed by looking at the rate of grade 3 to 5 adverse events 18 weeks after treatment initiation for each therapy.
Time frame: From treatment initiation to 18 weeks after treatment initiation.(up to 24 months)