Wednesday, December 20, 2017

Elderly melanoma patients and immunotherapy

A diagnosis of melanoma is devastating for anyone.  While effective treatment is what those of us with melanoma seek, it is understandable that considering therapy that is known to have the potential for significant side effects is concerning for all of us and likely even more so for elderly patients in need.  This earlier post helps diminish that concern:  With immunotherapy the elderly with melanoma may be down...but NOT out!!!  as the two patients in the case report tolerated immunotherapy with no greater difficulty than expected.  Now there's this:

Association of Immunotherapy With Overall Survival in Elderly Patients With Melanoma. Perier-Muzet, Gatt, Falandry, et al.  JAMA Dermatol. 2017 Dec 6.

Melanoma treatment has been revolutionized with the development of immune-based therapies that offer durable clinical responses in a subset of patients. Clinical outcomes after treatment by immunotherapy can be influenced by the host's immune system. The immune system is modified with age by age-related immune dysfunction.
To evaluate if age influences clinical outcome and immune adverse events in patients treated by immunotherapy for metastatic melanoma.

This was a single-center cohort analysis in patients treated with immunotherapy for metastatic melanoma between January 2007 and February 2016, in the Lyon Sud Hospital, France. A total of 92 patients with metastatic melanoma treated with ipilimumab, nivolumab, or pembrolizumab were retrospectively analyzed.

Overall survival, progression-free survival, and immune-related adverse events were evaluated for each treatment line according to the patients' age.

A total of 92 patients were eligible and included in this study for a total of 120 lines of treatment. Fifty-four patients were included in the cohort that was 65 years or younger (24 [44%] were female; mean [SD] age, 48.1 [12.5] years), and 38 patients were included in the cohort that was older than 65 years (12 [34%] were female; mean [SD] age, 74.8 [6.9] years). Mean follow-up duration starting at treatment initiation was 12.5 months. Patients older than 65 years treated with immunotherapy had a better mean progression-free survival (4.8 vs 3.4 months) and overall survival (not reached vs 10.1 months) than younger patients in univariate analysis, and after adjusting on prognosis covariates. This was particularly true with patients treated with anti-programmed cell death protein 1. Common immune-related adverse effects were similar in both cohorts.

Age might be associated with a better clinical outcome after treatment with immunotherapy in the real-life setting. In our cohort, older patients did not have more immune-related adverse events. Further studies are warranted to confirm our results and describe the underlying mechanisms involved.

In this study of 92 patients treated with ipi, nivo, or pembro at a hospital in France, 38 of them were older than 65.  In that older subset, there was no increase in adverse events and progression free survival and overall survival data was even better than it was in younger patients.  This could be  a fluke (the better response rates in particular) given it is a review of only one set of 38 patients, but we already know that younger patients diagnosed with melanoma often experience more devastating results than older patients do.  Here is a post from 2014:  With melanoma: You can never be too rich or too thin! But, you can be too young!!!

Either way, sounds like good news to me.  Chipping away at melanoma...bit by bit!!  - c

For fun and celebration, check out this amazing still life from my hometown....and an artist who just happens to be close to my heart and a fab researcher for this blog: - photo of the day ~ Brainerd barber shop  Well done, B!!!! - les

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