From the Guidelines
Dementia is not a contraindication to immunotherapy, and patients with dementia can receive immunotherapy treatments when clinically appropriate, considering their overall health status, life expectancy, and support system. The decision to use immunotherapy in patients with dementia should be made on a case-by-case basis, taking into account the potential benefits and risks, including immune-related adverse events that might be more challenging to identify or manage in dementia patients 1.
Key Considerations
- Individual assessment is necessary to determine the suitability of immunotherapy for patients with dementia, as cognitive impairment may affect their ability to report side effects, comply with treatment schedules, or provide informed consent.
- The patient's overall health status, cancer type and stage, life expectancy, goals of care, and support system should be considered when deciding to use immunotherapy.
- Potential benefits must be weighed against risks, including immune-related adverse events that might be more challenging to identify or manage in dementia patients.
- Some immunotherapies like checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab) may cause neurological side effects, though these are relatively rare.
- A multidisciplinary approach involving oncologists, geriatricians, neurologists, and caregivers is ideal when considering immunotherapy for dementia patients.
Evidence-Based Recommendations
- According to a recent study published in 2023, dementia symptomatology and management should be considered when making treatment decisions, including the use of immunotherapy 1.
- Another study published in 2011 found that there is no absolute upper age limit for initiation of immunotherapy, and the risk/benefit assessment must be evaluated in every situation 1.
- However, the most recent and highest-quality study 1 suggests that individual assessment and consideration of the patient's overall health status and support system are crucial when deciding to use immunotherapy in patients with dementia.
From the Research
Dementia and Immunotherapy
- Dementia is a complex condition characterized by the loss of cognitive function, affecting millions of people worldwide 2.
- Immunotherapy has been explored as a potential treatment for dementia, particularly for Alzheimer's disease, which is the most common cause of dementia 3, 4, 5.
- The goal of immunotherapy in dementia is to remove abnormal protein accumulations, such as amyloid-beta, that contribute to the disease 3, 4.
Safety of Immunotherapy in Dementia
- There is limited research on the safety of immunotherapy in patients with dementia, and most studies have focused on patients with solid tumors 6.
- A real-world study on the safety of extended dosing schedules for nivolumab and pembrolizumab in patients with solid tumors found that patients with pre-existing antibodies, particularly anti-thyroid antibodies, may be prone to developing immune-related adverse events (irAEs) after starting extended dosing intervals 6.
- However, it is unclear whether these findings can be applied to patients with dementia, and further research is needed to determine the safety and efficacy of immunotherapy in this population.
Contraindications to Immunotherapy
- There is no clear evidence to suggest that dementia is a contraindication to immunotherapy, but patients with dementia may be more susceptible to irAEs due to their underlying condition 6.
- Further research is needed to determine the potential benefits and risks of immunotherapy in patients with dementia, and to identify any potential contraindications or precautions that should be taken when using immunotherapy in this population.