Immunotherapy Outcomes in Advanced Melanoma in Relation to Age.

Abstract

INTRODUCTION:

Older age is a melanoma risk factor. Elderly individuals are likelier to have immunosenescence, which could help melanoma cells escape immune surveillance. Hence, it is believed that elderly people cannot mount a potent immune response to checkpoint inhibitors to eliminate melanoma.

OBJECTIVES:

To investigate age-related differences in the time to progression, overall survival, and immunotherapy-related adverse events among patients with metastatic melanoma who received checkpoint inhibitors.

METHODS:

We retrospectively identified patients at our institution between January 2012 and December 2016 with stage IV melanoma who received at least 1 dose of ipilimumab, pembrolizumab, nivolumab, or combined ipilimumab and nivolumab. Demographic, pathologic, and clinical characteristics were obtained. Immune-related response criteria were used to define responses.

RESULTS:

Twenty-nine patients were younger than age 65 years and 31 were age 65 years or older. Time to progression was comparable between the age groups (hazard ratio = 0.79, 95% confidence interval = 0.37-1.70, p = 0.46). Overall survival was not significantly different after immunotherapy between groups (hazard ratio = 0.75, 95% confidence interval = 0.31-1.82, p = 0.491). Overall, immunotherapy-related adverse events were comparable between groups, with 62% in younger patients (18/29) and 45% in older patients (14/31 p = 0.19). Of 60 patients, 30 responded to immunotherapy. Nonresponders were more likely than responders to have BRAF-mutated melanomas (16 [53.3%] vs 8 [27.6%]; p = 0.04) and less likely to have immunotherapy-related adverse events (12 [40%] vs 20 [66.7%]; p = 0.04).

CONCLUSION:

Aging does not seem to affect response to checkpoint inhibitors. Elderly patients with metastatic melanoma should be treated similarly to younger patients.

• Authors: Krishna Joshi, Dinesh Atwal, Rahul Ravilla, Yadav Pandey, Naveen Yarlagadda, Sunil Kakadia, Issam Makhoul, Laura Hutchins, Fade Mahmoud
• Journal: The Permanente journal (Perm J) Vol. 24 ( 2020) ISSN: 1552-5775 [Electronic] United States
• PMID: 32097116 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antineoplastic Agents, Immunological
• Immune Checkpoint Inhibitors
• Ipilimumab
• Nivolumab
• pembrolizumab
• BRAF protein, human
• Proto-Oncogene Proteins B-raf

Topics

• Aged
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antineoplastic Agents, Immunological (adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols
• Female
• Humans
• Immune Checkpoint Inhibitors (adverse effects, therapeutic use)
• Ipilimumab (therapeutic use)
• Male
• Melanoma (drug therapy, genetics, pathology)
• Middle Aged
• Neoplasm Staging
• Nivolumab (therapeutic use)
• Proto-Oncogene Proteins B-raf (genetics)
• Retrospective Studies
• Skin Neoplasms (drug therapy, genetics, pathology)
• Socioeconomic Factors
• Survival Analysis