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Ageing implicates a remodeling of our immune system, which is a consequence of the physiological senescence of our cells and tissues coupled with environmental factors and chronic antigen exposure. An immune system that senesces includes more differentiated cells with accumulation of highly differentiated CD4 and CD8 T cells. The pool of naive T cells decreases with the exponential thymic involution induced by age. Differentiated T cells have similar, if not higher, functional capacities but scarce studies are looking at the impact of senescence among specific T cells. After a stimulation, other immune cells (monocytes, dendritic cells and NK) are functionally altered during ageing. It is as if the immune system was more efficient at the basal level, but less efficient after a stimulation in the old compared to young people, likely due to less reserve. Concerning the clinical impact, older people are more prone to certain pathogens and their clinical manifestations differ from the younger people. Severe flu and VZV reactivation are more frequent with an altered cellular response to vaccination. Vaccination failure can have detrimental consequences in people presenting frailty criteria. Old people frailty is majored by their comorbidities and diseases like cancer. Thus, chemotherapies are employed with circumspection in older patients. The use of anti-PD-1/PD-L1 immunotherapies is therefore attractive, because of less side effects with a better response compared to chemotherapy. Old persons inclusion is lacking in current studies and clinical trials. Some subgroups or pooled analyses confirm the gain in response without increased toxicities in older patients but their inclusion criteria differ from the real-life practice. Specific studies focusing on this population are needed because of the increasing cancer incidence with age and the overall ageing of the population.

The G8 screening tool has been developed to identify older cancer patients requiring a geriatric assessment for tailoring therapy. Little is known about its prognostic value, particularly by tumour site. An optimised version has been recently developed, but no prognostic information is available. We compared the prognostic value of both instruments overall and by tumour site.Data were from a prospective cohort of cancer patients ≥70 years old referred to 1 of 6 French geriatric oncology clinics between 2007 and 2014 (n = 1333). Endpoints were overall 1- and 3-year survival. Cox proportional-hazards models were built to assess the predictive value of abnormal G8 and modified-G8 scores, based on published cut-offs or by classes of increasing risk. Sensitivity analyses involved adjusting for age, gender, treatment, metastasis, and tumour site (digestive, breast, urinary tract, prostate, other solid cancers, and haematological malignancies) and stratifying by tumour site and metastatic status.Abnormal scores were independently associated with overall 1-year survival: adjusted hazard ratio [aHR] = 4.3[G8]/4.9[modified-G8] and 3-year survival: aHR = 2.9/2.6; all p 0.0001. Associations persisted after stratifying by metastatic status and in most cancer sites (exceptions: colorectal (G8) and upper digestive cancer (both tools) [1-year analysis]; digestive cancers (both tools) [3-year analysis]). For both tools, classes of increasing risk showed a graded relationship with mortality (p 0.0001).Our results identified both abnormal G8 and modified-G8 scores as strong and consistent predictors of overall survival, regardless of metastatic status or tumour site. These findings strengthen the clinical utility of these instruments in the geriatric oncology setting.

Background Direct oral anticoagulants (DOACs) are effective to prevent strokes; however, bleeding risk of DOACs in very old and frail geriatric patients is poorly known. Purpose : To assess bleeding risk in geriatric patients aged ≥ 80 years with AF newly treated with rivaroxaban. Methods Subjects from 33 centers, with non-valvular AF newly treated with rivaroxaban were enrolled and followed-up every 3 months for 12 months. Clinical and biological data were recorded. Major bleedings were recorded at each visit. The cohort was compared with a cohort treated with vitamin K antagonists (VKA) from the same centers (n = 924). Results In total, 995 subjects had a 1-year follow-up. The mean (standard deviation (SD)) age was 86.0 (4.3) years, 23% were aged 90 years and older. 61% were women and 48% had an estimated glomerular filtration rate (eGFR) Conclusions In this first large-scale prospective study in geriatric population with AF, major bleeding rates were significantly lower with rivaroxaban than with VKAs.

Background The emergence of ICIs has modified the treatment of many types of cancers. However, efficacy and safety data of such agents (anti PD-1/anti PD-L1) are cruelly missing in elderly patients ⩾ 80 year-old. Methods A retrospective monocentric study was conducted between April 2015 and April 2019 in all ⩾ 80 year-old ICIs-treated patients, as a part of a clinical trial or standard of care. Patients/disease characteristics were collected using electronic medical records. Clinical response was assessed according to iRECIST criteria; survival was estimated according to Kaplan-Meier method and toxicity was assessed according to CTCAE v 4.0. Results Of the 415 patients who received an ICI, 42 (10.1%) were aged ⩾ 80 years (median: 84; range: 80-93). The most represented tumour types were NSCLC (45.2%), renal cell carcinoma (30.9%) and bladder carcinoma (16.7%). 92.9% were stage IV. ICIs were given as first-line therapy in 7 patients (16.7%) and as second-line or beyond in 35 patients (83.3%). 29 patients had nivolumab, 10 patients had pembrolizumab and 3 had atezolizumab. ICIs were given mostly as monotherapy (97.6%). A median of 7.5 doses were administered (range: 1-37). Of the 42 patients, 40.5% were PS ⩾ 2 and 88.1% had impaired G8 score. Mean Charlson Index was 3 (range: 0-6), polypharmacy was present in 26 cases and 35.7% had an albumin level Conclusions ICIs appear to be an acceptable treatment option for octogenarian patients, with manageable toxicity. Legal entity responsible for the study Mebarki Soraya. Funding Has not received any funding. Disclosure E. Fabre: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): BMS; Honoraria (self): Merck. S. Oudard: Research grant / Funding (self): Boehringer; Honoraria (self): Ipsen; Honoraria (self): Bayer; Honoraria (self), Travel / Accommodation / Expenses: Pfize; Honoraria (self), Travel / Accommodation / Expenses: MSD; Honoraria (self), Travel / Accommodation / Expenses: Astellas; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Janssen; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: BMS; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Sanofi. E. Paillaud: Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self): Servier; Honoraria (self), Travel / Accommodation / Expenses: Roche. All other authors have declared no conflicts of interest.

A 2-month follow-up of nutritional status was performed in forty elderly patients with recent hip fracture. Patients were nutritionally assessed on admission to our rehabilitation unit (day 0), then monthly (day 30, day 60) by measurement of resting energy expenditure (REE), anthropometric, impedance and biological variables. Patients were defined as undernourished (n 13) or normally nourished (n 27) on the basis of mid-arm circumference (MAC) and triceps skinfold thickness (TST) measurements. Seven patients recovered a walking autonomy and were discharged from the hospital before day 30 (group I) whereas thirteen patients were discharged after day 30 (group II); twenty patients remained in the study at day 60 (group III). MAC and TST decreased in normally nourished patients from group III throughout the study whereas they did not change in group II or in undernourished patients from group III. REE values in relation to fat-free mass were increased compared with normal values and were similar in the three groups on day 0; they did not change during the study. Daily energy intake in relation to body weight was higher in group I and increased in group II and in undernourished patients from group III throughout the study. In contrast, it was below the recommended value at day 0 and it did not significantly improve in normally nourished patients from group III. Serum albumin, transthyretin and transferrin levels on day 0 were below reference intervals in the three groups. Albumin levels increased in group III throughout the study. Inflammatory proteins decreased in groups II and III, with C-reactive protein levels returning to normal values in group II by day 30 and in group III at day 60, while orosomucoid levels did not become completely normal over this period. Our findings indicate no improvement in nutritional status in undernourished patients after surgery for recent hip fracture, despite an adequate energy intake. An insufficient spontaneous energy intake for normally nourished patients was associated with a delayed favourable outcome resulting in a prolonged duration of hospitalization. A hypermetabolic state persisted during the 3 months after surgery.