{
  "abstract": "Background Immune checkpoint inhibitors (ICIs) are increasingly used in triple-negative breast cancer (TNBC), particularly in the metastatic and early-stage settings. 1 2 However, older adults remain underrepresented in pivotal immunotherapy trials, limiting real-world guidance on tolerability and long-term outcomes in this population.3 We conducted a real-world analysis of age-associated differences in immune-related adverse events (irAEs), treatment discontinuation, and 5-year mortality in patients receiving ICIs for TNBC.Methods We used the TriNetX global federated research network to identify adult female patients diagnosed with TNBC (ER-/PR-/HER2-) who received at least one dose of an ICI (pembrolizumab, atezolizumab, nivolumab, or durvalumab) between 2014 and 2025. Patients were stratified into two age-based cohorts: <70 years and ≥70 years. A total of 4,462 patients were included (2,231 per group). Outcomes assessed included 5-year all-cause mortality and incidence of irAEs such as colitis/gastroenteritis, hepatitis, thyroid dysfunction, pneumonitis, rash, and myalgia. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Results Five-year mortality was higher in the older cohort (26.8%) compared to the younger group (18.8%), with an OR of 0.63 (95% CI: 0.55–0.73). While most irAEs occurred at similar rates across age groups, hepatitis was more common in younger patients (3.8% vs 2.6%; OR: 1.49; 95% CI: 1.06–2.1). Myalgia was the only toxicity significantly more frequent in older adults (2.2% vs 1.0%; OR: 2.25; 95% CI: 1.03–4.92). Rates of colitis, pneumonitis, hospitalizations, and steroid use were comparable. Treatment duration trends showed earlier discontinuation in older adults, though not statistically significant.Conclusions In this large, real-world cohort of TNBC patients treated with ICIs, older adults (≥70 years) had higher 5-year mortality but did not experience a disproportionate burden of most irAEs. These results support the continued use of ICIs in older patients while highlighting the importance of age-sensitive toxicity monitoring and survivorship planning. Real-world evidence such as this is critical for informing age-inclusive treatment decisions and improving the generalizability of immunotherapy outcomes in breast cancer.Acknowledgements We thank Jake Loughridge for his assistance with data extraction and cohort matching, and the TriNetX support team for enabling access to de-identified real-world data.References Emens LA. Breast cancer immunotherapy: facts and hopes. Clin Cancer Res. 2018; 24(3): 511–520.Cortes J, Cescon DW, Rugo HS, et al. Pembrolizumab plus chemotherapy in advanced triple-negative breast cancer. N Engl J Med. 2020;382:810–821.Ludmir EB, Subbiah IM, Mainwaring W, et al. Decreasing incidence of upper age exclusion in cancer clinical trials. J Geriatr Oncol. 2020;11(1):107–109.Ethics Approval This study used de-identified, retrospective data from the TriNetX network and was exempt from IRB approval and informed consent per institutional and regulatory guidelines.Consent Not applicable. This study used de-identified, retrospective data from a federated EHR network and did not involve direct patient interaction.",
  "authors": [
    {
      "affiliations": [
        "UPMC, Harrisburg, PA, USA"
      ],
      "name": "Fatma B Yilmaz"
    },
    {
      "affiliations": [
        "Drexel University College of Medicine, Philadelphia, PA, USA"
      ],
      "name": "Jake Fanizza"
    },
    {
      "affiliations": [
        "UPMC, Harrisburg, PA, USA"
      ],
      "name": "Sulochana Khadka"
    },
    {
      "affiliations": [
        "UPMC, Harrisburg, PA, USA"
      ],
      "name": "Ali Sanjari Moghaddam"
    },
    {
      "affiliations": [
        "UPMC, Harrisburg, PA, USA"
      ],
      "name": "Anas Atrash"
    }
  ],
  "title": "1078 Age-associated outcomes in triple-negative breast cancer patients treated with immune checkpoint inhibitors: a real-world analysis of toxicity and survival in adults <70 vs ≥70 years",
  "uid": "bbe28668-8d93-5883-b870-64a608f1428f"
}