Treatment of older patients with immune checkpoint inhibitors in routine clinical care as compared to inclusion in pivotal registration trials

The introduction of ipilimumab for treatment of advanced melanoma marked a new era of anticancer treatment with immunotherapy. Ipilimumab was the first drug to markedly improve survival of patients diagnosed with advanced melanoma [ [1] ]. The mechanism of action of immunotherapy fundamentally differs from classical anticancer treatment, for these agents potentiate an antitumor immune response. In the past years several immune checkpoint inhibitors (ICIs) have been granted market approval. ICIs are monoclonal antibodies that block negative regulators of T-cell activation. By binding to e.g. cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) or programmed-death-receptor-1 (PD-1), T-cell activation and proliferation is enhanced. ICIs are used against various tumour types, especially those with a high mutational load, e.g. melanoma and non-small cell lung cancer (NSCLC). As a large proportion of their intended patient population concerns older adults, ICIs may be frequently administered to older patients (aged ≥65 years)