TY - JOUR
T1 - Outcomes for systemic therapy in older patients with metastatic melanoma: Results from the Dutch Melanoma Treatment Registry
AU - Jochems, A.
AU - Bastiaannet, E.
AU - Aarts, M.J.B.
AU - van Akkooi, A.C.J.
AU - van den Berkmortel, F.W.P.J.
AU - Boers-Sonderen, M.J.
AU - van den Eertwegh, A.J.M.
AU - de Glas, N.G.
AU - de Groot, J.W.B.
AU - Haanen, J.B.A.G.
AU - Hospers, G.A.P.
AU - van der Hoeven, J.J.M.
AU - Piersma, D.
AU - van Rijn, R.S.
AU - Suijkerbuijk, K.P.M.
AU - ten Tije, A.J.
AU - van der Veldt, A.A.M.
AU - Vreugdenhil, G.
AU - van Zeijl, M.C.T.
AU - Kapiteijn, E.
AU - Wouters, M.W.J.M.
N1 - Funding Information:
Conceptualization : Anouk Jochems (AJ), Esther Bastiaannet (EB), Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH). Data curation : Anouk Jochems (AJ), Esther Bastiaannet (EB), Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH), Maureen J.B Aarts (MA), Franchette W.P.J. van den Berkmortel (FB), Marye J. Boers-Sonderen (MB), Alfonsus J.M. van den Eertwegh (AE), Nienke A. de Glas (NG), Jan Willem B. de Groot (JG), John B.A.G. Haanen (JH), Geke A.P. Hospers (GH), Djura Piersma (DP), Rozemarijn S. van Rijn (RR), Karijn P.M. Suijkerbuijk (KS), Albert Jan ten Tije (AT), Astrid A.M. van der Veldt (AV), Gerard Vreugdenhil (GV), Michiel C.T. van der Zeijl (MZ). Formal analysis : Anouk Jochems (AJ), Esther Bastiaannet (EB), Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH). Funding acquisition : None for this article in particular. The DMTR was funded with a grant from the Netherlands Organization for Health Research and Development. Investigation : Anouk Jochems (AJ), Esther Bastiaannet (EB), Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH). Methodology : Anouk Jochems (AJ), Esther Bastiaannet (EB), Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH). Project administration : Anouk Jochems (AJ). Resources : The Dutch Melanoma Treatment Registry. Software : STATA/SE (version 12.0, Statacorp LP, Texas, USA). Supervision : Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH). Validation : the manuscript has been reviewed and approved by all co- authors. Visualization : Anouk Jochems (AJ), Esther Bastiaannet (EB). Writing Original Draft : Anouk Jochems (AJ), Esther Bastiaannet (EB), Ellen Kapiteijn (EK), Michel W.J.M Wouters (MW), Jacobus J.M. van der Hoeven (JvdH). Writing review & editing : the manuscript has been reviewed and approved by all co-authors. The first author (AJ) edited all feedback and changes.
Funding Information:
The Netherlands Organisation for Health Research and Development funded the start-up of the DMTR (grant number 836002002). This grant was awarded under the effectiveness research for high-cost medicine programme. From its foundation the DMTR was sponsored by BMS, GSK (later acquired by Novartis), Roche Nederland BV and MSD (from 2015). Roche Nederland B.V. stopped and Pierre Fabre started funding of the DMTR in 2019. This manuscript received no external funding.
Publisher Copyright:
© 2021 The Authors
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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/).
AB - 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/).
KW - Metastatic melanoma
KW - Older patients
KW - Targeted therapy
KW - Immune checkpoint inhibitors
KW - Safety
KW - Outcome
KW - IMMUNE CHECKPOINT INHIBITORS
KW - STAGE-III
KW - DOUBLE-BLIND
KW - IPILIMUMAB
KW - IMMUNOTHERAPY
KW - DABRAFENIB
KW - NIVOLUMAB
KW - AGE
KW - MULTICENTER
KW - VEMURAFENIB
U2 - 10.1016/j.jgo.2021.04.006
DO - 10.1016/j.jgo.2021.04.006
M3 - Article
C2 - 34020909
SN - 1879-4068
VL - 12
SP - 1031
EP - 1038
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 7
ER -