Outcome of Nivolumab Therapy in Elderly Esophageal Cancer Patients

Abstract

Nivolumab is strongly recommended as second-line therapy for unresectable advanced or recurrent esophageal cancer. This recommendation was based on the ATTRACTION-3 trial, which did not include patients aged 75 years or older; thus, the efficacy and safety of nivolumab in elderly patients with esophageal cancer remains unclear. We retrospectively evaluated the efficacy and safety of nivolumab in 23 patients older than 75 years who had received the drug at the study center. The median age was 78 years (range: 75-84). Twenty-two patients had squamous cell carcinoma, and one patient had basaloid squamous cell carcinoma. The reason for treatment was postoperative recurrence in nine patients (eight recurrences after radical resection and one recurrence after ESD) and non-excision in 14 patients. Fourteen patients received radiation therapy before or after receiving nivolumab. The target lesions treated (multiple choice) included 26 lymph node metastases (six cervical, nine mediastinal, ten abdominal, and one axillary), 13 primary lesions, and nine lung metastases. Adverse events of all grades occurred in 16 patients (69%), and grade 3 or higher events occurred in eight patients (34%). The response rate was 14%, and the disease control rate was 47% in three patients with PR, eight patients with SD, and 12 patients with PD. The median overall survival was 12.7 months. Nivolumab therapy for elderly patients with esophageal cancer was associated with a high incidence of adverse events, suggesting the need for adequate adverse event screening.