The immunosenescence is really a bad term because we try to introduce a sort of bias by thinking that everything which goes on in the immune system is bad for the elderly individual. Recently perhaps we think that the changes in the immune system with aging are not just senescence but can be a sort of adaptation. These changes, of course, are decreasing, increasing and there are so many cell types, so many functions, so many things which go on that we cannot really see a trend for everything that’s going on. Since we have the new immunotherapy that we can see in cancer and in other parts of medicine we knew that it can be exactly the same significance in the elderly. So it questioned also whether the immunosenescence, the so-called immunosenescence, is really a sort of senescence or really something that can adapt during the life of the individual during all the immunological change that they could undergo. This means that nevertheless they can respond to an immunotherapy so that’s what we are trying to put forward, that in fact the age of the subject is not a limit for doing immunotherapy.
How are people responding to this challenge?
This is somehow quite detrimental for the elderly because in many settings like vaccination, treatments, immunotherapy, cancer treatments, rheumatoid disease treatments, many elderly are just excluded from the trials and also from the treatment on an everyday basis because they are just old. They are excluded because they think that the elderly immune system is not so good as in young people so they cannot answer to the treatment sufficiently so it’s useless to do these treatments in these patients.
Where do we go next with immunotherapy in this setting?
It has a very great future. If we understand much better in a different way our immune system with aging and we can really extract what is beneficial for the elderly even in the immune changes or what we call the inflam-aging, so the inflammatory setting with aging, we can really use immunotherapy. Of course, immunotherapy will never be just one shot, it will be a combined immunotherapy so we should really, when we understand how the immune cells can really combat the cancer and may help for the immuno-surveillance for the cancer cells, then we can use this therapy much more efficiently, either in the elderly or in young people, whatever is the age. It’s not the age which is really the determinant but this is the nature of the tumour, the nature of the immune response, the nature of the inflammatory status of the person which are the most important when we decide whether to use or not the immunotherapy. The next years will be very beneficial for the elderly by using several types because we use mainly the inhibitory checkpoint treatment for the PD1, for the CTLA4, but there are many other things that we can use against the anti-inflammatory cytokines like TGF-β, IL-10 or even for increasing the co-stimulatory receptor activities. So there are many other targets that can be used in immunotherapy, not only the PD1 or the CTLA4 which are the most known actually, but with the research we can really increase the diversity of the immunotherapy.
