By David Douglas
NEW YORK (Reuters Health) - After immunotherapy for metastatic melanoma, patients over age 65 appear to show equivalent, and perhaps better, clinical outcome than their younger counterparts, according to a small retrospective study from France.
For their study, published online December 6 in JAMA Dermatology, Dr. Amelie Boespflug of Lyon Sud Hospital and colleagues examined whether the age of patients with metastatic melanoma affected response and tolerance to immunotherapy in a real-world clinical setting.
They analyzed data on 92 patients who had received ipilimumab, nivolumab, or pembrolizumab (120 lines of treatment in all) at their institution between 2007 and 2016. Thirty-eight patients (41%) were age 65 or older; the rest were younger. Mean follow-up, starting at treatment initiation, was 12.5 months.
In multivariable analyses, the older group had significantly longer progression-free survival (PFS) than the younger group (mean, 4.8 vs. 3.4 months). An overall survival (OS) point was not reached in the older patients, compared to 10.1 months in the younger patients. The survival findings persisted whether patients had been treated with ipilimumab versus with pembrolizumab or nivolumab.
Age was independently associated with better OS and PFS. The older and younger groups did not differ in their incidence of the most common immune-related adverse events.
The researchers concede that "the biological mechanisms that might contribute to better responses in older patients were not evaluated." But they note that although the study was small and retrospective, the findings "might be more reflective of current practice, as our patients were unselected and therefore tended to have more polymedication, more prior treatments, and more severe diseases than in clinical trials."
The results, they conclude, confirm that "age should not be a limiting factor for immunotherapy."
Dr. Caroline Robert, head of the Dermatology Unit at the Gustave-Roussy Institute, Paris, told Reuters Health by email, "This is important information to remind physicians that there is no reason to limit access to immunotherapy monotherapy in elderly patients."
"Indeed," she added, "this series shows that both in terms of efficacy and safety, patients over 65 do at least as well, or even better,” noting that she and her colleagues "have similar data submitted for publication on a larger series of patients."
Many hypotheses may be suggested to account for these findings, Dr. Robert explained, “(but) from my point of view, the mutational load is among the most plausible because older patients might have more 'sun-exposed' melanoma. But this remains to be demonstrated."
Dr. Boespflug did not respond to requests for comment.
JAMA Dermatol 2017.
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