How do immunotherapy and chemotherapy help elderly patients?

Question

Hello doctor,

My grandfather is 75 years old and has started treatment with chemotherapy and immunotherapy for lung cancer. We were concerned about his age and possible side effects. After the first cycle, he experienced fatigue and a mild fever. His CRP levels increased but later settled.

How does immunotherapy combined with chemotherapy help a 75-year-old lung cancer patient?
Does age reduce the benefit or response to treatment?
Are side effects more severe in elderly patients?

His programmed death-ligand 1 (PD-L1) level is 40 percent, and his kidney function is borderline, with a creatinine level of 1.5. We would like to know whether this combination treatment truly improves survival or mainly provides disease control.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

Starting both chemotherapy and immunotherapy together may seem intensive, but this combination is commonly used in current practice because it often provides better overall outcomes in suitable patients.

Immunotherapy works by helping the body’s immune system recognize and attack cancer cells. Chemotherapy, in addition to directly reducing tumor burden, can also make cancer cells more visible to the immune system. When used together, these treatments complement each other, which is why the combination is used not only to slow disease progression but also to improve survival in appropriate cases.

Age alone does not significantly reduce the benefit of this treatment. What matters more is the patient’s overall health, activity level, and ability to tolerate treatment. Many patients in their 70s are able to tolerate this approach reasonably well if they maintain good functional status. Therefore, age by itself should not be considered a limiting factor for treatment response.

The side effects observed after the first cycle, such as fatigue, mild fever, and elevated C-reactive protein (CRP), are commonly seen and often settle, as in this case. Elderly patients may experience these effects more noticeably, but they are not necessarily more dangerous if closely monitored. Regular follow-up and early reporting of symptoms are important.

A programmed death-ligand 1 (PD-L1) level of 40 percent suggests that immunotherapy is likely to play a meaningful role in treatment. In such cases, adding immunotherapy to chemotherapy has been shown to improve response rates and overall survival compared to chemotherapy alone, rather than only providing temporary disease control.

A creatinine level of 1.5 mg/dL indicates the need for careful monitoring of kidney function. Chemotherapy doses can be adjusted if required, and immunotherapy is generally less harmful to kidney function. However, close supervision by the treating doctor is essential.

Overall, based on the information provided, this combination treatment is being used with the goal of achieving better disease control as well as improved survival, not just short-term benefit.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.