Outcomes for systemic therapy in older patients with metastatic melanoma: Results from the Dutch Melanoma Treatment Registry

A. Jochems*, E. Bastiaannet, M.J.B. Aarts, A.C.J. van Akkooi, F.W.P.J. van den Berkmortel, M.J. Boers-Sonderen, A.J.M. van den Eertwegh, N.G. de Glas, J.W.B. de Groot, J.B.A.G. Haanen, G.A.P. Hospers, J.J.M. van der Hoeven, D. Piersma, R.S. van Rijn, K.P.M. Suijkerbuijk, A.J. ten Tije, A.A.M. van der Veldt, G. Vreugdenhil, M.C.T. van Zeijl, E. KapiteijnM.W.J.M. Wouters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: The incidence of metastatic melanoma is increasing in all ages. Multiple trials with targeted drugs and immune checkpoint inhibitors showed improved survival in metastatic melanoma. However, patients aged >_75 years are often under-represented in clinical trials, therefore raising questions on safety and efficacy of treatment. Patients and methods: We analyzed a real-world cohort of 3054 patients with metastatic melanoma stratified for age (<_65 years, 66-74 years and >_ 75 years), and BRAF status, providing data on treatment strategies, toxicity, and survival. Kaplan Meier curves and Cox Proportional Hazard Models were used to present overall survival (OS) and Melanoma Specific Survival (MSS). Results: Overall, 52.2% of patients were <_ 65 years and 18.4% of patients >_75 years. BRAF mutated tumors were found less often in patients >_75 years: 34.5% versus 65% in patients <_65 years. Patients >_75 years received systemic therapy less frequently compared to their younger counterparts independent of the BRAF status. When receiving treatment, no statistical significant difference in grade 3 or 4 toxicity was observed. Three year Overall Survival rate was 13.7% (9.1-19.3) in patients >_75 years versus 26.7% (23.1-30.4) in patients <_65 years, with a Hazard Ratio (HR) of 1.71 (95%CI 1.50-1.95), p < 0.001. Three year Melanoma Specific Survival was 30.4% (22.0-39.2) versus 34.0% (29.7-38.2), HR 1.26 (95% CI 1.07-1.49), p = 0.005 with an adjusted HR of 1.21 (1.00-1.47), p = 0.049 Conclusion: Patients with metastatic melanoma >_75 years are less frequently treated, but when treated there is no statistical significant increase in toxicity and only a borderline statistical significant difference in Melanoma Specific Survival was seen, compared to younger patients. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
Original languageEnglish
Pages (from-to)1031-1038
Number of pages8
JournalJournal of Geriatric Oncology
Volume12
Issue number7
DOIs
Publication statusPublished - 1 Sep 2021

Keywords

  • Metastatic melanoma
  • Older patients
  • Targeted therapy
  • Immune checkpoint inhibitors
  • Safety
  • Outcome
  • IMMUNE CHECKPOINT INHIBITORS
  • STAGE-III
  • DOUBLE-BLIND
  • IPILIMUMAB
  • IMMUNOTHERAPY
  • DABRAFENIB
  • NIVOLUMAB
  • AGE
  • MULTICENTER
  • VEMURAFENIB

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