Ipilimumab/Nivolumab and Geriatric Care: Valuing Patient Priorities

While first-line ipilimumab (Yervoy) plus nivolumab (Opdivo) demonstrated comparable overall survival (OS) and time on therapy for patients aged 70 years and older with metastatic clear cell renal cell carcinoma (mccRCC) vs younger patients, Antonio Ocejo, MD, emphasized the necessity of comprehensive geriatric assessments to guide individualized treatment decisions.

In an interview with Oncology Nursing News at the 2026 ASCO Genitourinary Cancers Symposium, Ocejo notes that beyond traditional performance status, oncology teams must evaluate a patient’s daily living, the robustness of their home support systems, and the specific values of the patient and their family to ensure treatment aligns with their priorities throughout the cancer journey.

Comparative Outcomes and Tolerability in Older Adults

A multi-institutional retrospective analysis of 514 patients treated at Memorial Sloan Kettering Cancer Center and MD Anderson Cancer Center in Houston, Texas, compared clinical outcomes between patients age 70 years or older (n=98) and those younger than 70 years (n = 416). The study found that median OS was similar between the groups, at 5.0 years (95% CI, 11-16) for older patients and 4.2 years (95% CI, 3.5-5.8) for younger patients (P = .85). Additionally, the median time on therapy was comparable, at 4.2 months and 5.3 months, respectively.

Older patients had a significantly longer median time to second-line therapy (TT2) at 27 months compared to 13 months in the younger cohort (P = .005). However, the researchers noted that sarcomatoid or rhabdoid features were less frequent in the older population (20% vs 39%; P <.001).

Clinical Implications for Adverse Event Management

Fewer patients in older patients completed all 4 induction doses of the combination (53% vs 65%; P = .04). Further, adverse event-related discontinuation was significantly higher in the older group, occurring in 42% of patients compared to 25% of younger patients (P <.001).

Ocejo suggests that as the field of geriatric oncology evolves, the focus must shift toward a more nuanced understanding of patient robustness. Assessing how independent a patient is with their daily activities and identifying the strength of their support system are essential steps for the care team. These findings support the use of ipilimumab and nivolumab in older adults but underscore the importance of proactive monitoring for toxicities that may lead to early treatment cessation.

Transcript

As the field is evolving, we are paying more attention to geriatric oncology. It is very important to understand the elements of a geriatric assessment when a patient walks into our office, as well as what they value and what they are hoping to get out of the treatment.

Assessing a patient is not only about patients’ performance status; it is also about taking a look at how independent they are with their activities of daily living, how robust of a support system they have at home, what the values of the patient and their family are, and what they want to prioritize throughout their cancer journey.

This transcript has been edited for clarity and conciseness.

Reference

Ocejo A, Dizman N, Doshi SD, et al. Clinical outcomes and tolerability of ipilimumab/nivolumab in older (≥70 years) versus younger patients with metastatic clear cell RCC: A multi-institutional analysis of 514 patients. J Clin Oncol. 2026;44(suppl17):444. doi:10.1200/JCO.2026.44.7_suppl.444