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Immunotherapy and Radiotherapy for Older Cancer Patients during the COVID-19 Era: Proposed Paradigm by the International Geriatric Radiotherapy Group

Nguyen NP 1 , Baumert BG 2 , Oboite E 1 , Motta M 3 , Appalanaido GK 4 , Arenas M 5 Show all authors , Lara PC 6 , Bonet M 7 , Zamagni A 8 , Vuong T 9 , Popescu T 10 , Karlsson U 11 , Trigo L 12 , Sun Myint A 13 , Thariat J 14 , Vinh-Hung V 15

Affiliations 

  • 1 Department of Radiation Oncology, Howard University, Washington, District of Columbia, USA
  • 2 Institute of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
  • 3 Department of Radiation Oncology, Hospital Papa Giovanni XXIII, Bergamo, Italy
  • 4 Advanced Medical & Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
  • 5 Department of Radiation Oncology, Sant Joan de Reus University, University Rovira I Virgili, Tarragona, Spain
  • 6 Department of Radiation Oncology, Fernando Pessoa Canarias Las Palmas University, Las Palmas, Spain
  • 7 Department of Radiation Oncology, Arnau de Villanova University Hospital, Lleida, Spain
  • 8 Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, and Department of Experimental, Diagnostic, and Specialty Medicine, -DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
  • 9 Department of Radiation Oncology, McGill University, Montreal, Québec, Canada
  • 10 Department of Radiation Oncology, Amethyst Radiotherapy Center, Cluj, Romania
  • 11 Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, District of Columbia, USA
  • 12 Service of Brachytherapy, Instituto Portugues de Oncologia Francisco Martins Porto E.P.E., Porto, Portugal
  • 13 Department of Radiation Oncology, Clatterbridge Cancer Center, Liverpool, United Kingdom
  • 14 Department of Radiation Oncology, Baclesse Cancer Center, Caen, France
  • 15 Department of Radiation Oncology, University Hospital of Martinique, Martinique, France
Gerontology, 2021;67(4):379-385.
PMID: 33784693 DOI: 10.1159/000514451

Abstract

BACKGROUND: Older cancer patients with locally advanced or metastatic disease may benefit from chemotherapy alone or combined with radiotherapy. However, chemotherapy is often omitted either because of physician bias or because of its underlying comorbidity, thus compromising their survival. The coronavirus disease 19 (COVID-19) pandemic is compounding this issue because of the fear of immunosuppression induced by chemotherapy on the elderly which makes them more vulnerable to the virus.

SUMMARY: Immunotherapy has less effect on the patient bone marrow compared to chemotherapy. The potential synergy between radiotherapy and immunotherapy may improve local control and survival for older patients with selected cancer. Preliminary data are encouraging because of better survival and local control in diseases which are traditionally resistant to radiotherapy and chemotherapy such as melanoma and renal cell carcinoma. Key Message: We propose a new paradigm combining immunotherapy at a reduced dose and/or extended dosing intervals and hypofractionated radiotherapy for older patients with selected cancer which needs to be tested in future clinical trials.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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