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Brief Report
January 2018

Association of Immunotherapy With Overall Survival in Elderly Patients With Melanoma

Author Affiliations
  • 1Dermatology Unit, Lyon Sud University Hospital, Pierre Bénite, France
  • 2Cancer Research Center of Lyon, Claude Bernard Lyon–1 University, INSERM 1052, CNRS 5286, Centre Leon Berard, Lyon, France
  • 3Medical Oncology Department, Lyon Sud University Hospital, Pierre Bénite, France
  • 4ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
  • 5Evolutionary Biology and Biometry Laboratory, Université Lyon 1, CNRS UMR 5558, Villeurbanne, France
  • 6Geriatrics Unit, Lyon Sud University Hospital, Pierre Bénite, France
  • 7Laboratoire CarMeN INSERM U.1060/Université Lyon1/INRA 1397/INSA Lyon/Hospices Civils de Lyon, Faculté de Médecine Lyon Sud, Oullins, France
JAMA Dermatol. 2018;154(1):82-87. doi:10.1001/jamadermatol.2017.4584
Key Points

Question  Does age influence clinical outcomes and tolerance to immunotherapy in metastatic melanoma?

Finding  In this retrospective cohort study in a real-life setting, patients older than 65 years treated by immunotherapy for a metastatic melanoma 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. Common immune-related adverse effects were similar in both cohorts.

Meaning  Age might be associated with a better clinical outcome after treatment with immunotherapy in the real-life setting, and older patients did not have more immune-related adverse events.

Abstract

Importance  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.

Objective  To evaluate if age influences clinical outcome and immune adverse events in patients treated by immunotherapy for metastatic melanoma.

Design, Setting, and Participants  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.

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

Results  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; P = .04) and overall survival (not reached vs 10.1 months; P = .009) 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.

Conclusions and Relevance  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.

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