Immunotherapy Efficacy in Malignant Melanoma Not Affected by Age

Malignant melanoma under microscope
Malignant melanoma under microscope
Patients older than 65 had better median progression-free survival and overall survival than those 65 or younger.

Patients >65 years of age with metastatic melanoma who are treated with immunotherapy do not have an increased risk for immune-related adverse events (AEs), according to the results of a recent single-center, retrospective cohort study published in JAMA Dermatology.

The investigators sought to evaluate whether age is associated with clinical outcomes among patients with metastatic melanoma treated with immunotherapy. A total of 92 patients with metastatic melanoma who were treated between January 2007 and February 2016 with ipilimumab, nivolumab, or pembrolizumab were enrolled in the study. The primary end points included overall survival (OS) and progression-free survival (PFS). OS was defined as the time from treatment initiation to death from any cause.

PFS was defined as the time from treatment initiation to progressive disease or death from any cause — whichever occurred first. Secondary end points included the percentage of immune-related AEs and the type of AEs based on patient age.

Overall, 92 patients were enrolled in the study for a total of 120 lines of treatment. There were 54 patients in the cohort ≤65 years of age (44% women; mean age, 48.1±12.5 years) and 38 participants in the cohort >65 years of age (34% women; mean age, 74.8±6.9 years). Mean follow-up duration beginning at treatment initiation was 12.5 months.

Participants >65 years of age who were treated with immunotherapy (ipilimumab and antiprogrammed cell death protein 1) had better median PFS (4.8 months [95% CI, 3.5-6.8] vs 3.4 months [95% CI, 2.7-3.0], respectively; P =.04) and median OS (not reached [95% CI, 16.1-not reached] vs 10.1 months [95% CI, 7.3-21.1], respectively; P =.009) than those ≤65 years of age. The occurrence of common immune-related AEs was similar in both cohorts.

The investigators concluded that age should not be a limiting factor for immunotherapy in patients with malignant melanoma. Additional studies are warranted to confirm these findings and describe the underlying mechanisms involved.

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Perier-Muzet M, Gatt E, Péron J, et al. Association of immunotherapy with overall survival in elderly patients with melanoma. JAMA Dermatol. 2018;154(1):82-87.