Anouk Jochems1, Esther Bastiaannet2, Maureen J B Aarts3, Alexander C J van Akkooi4, Franchette W P J van den Berkmortel5, Marye J Boers-Sonderen6, Alfonsus J M van den Eertwegh7, Nienke G de Glas8, Jan Willem B de Groot9, John B A G Haanen10, Geke A P Hospers11, Jacobus J M van der Hoeven12, Djura Piersma13, Rozemarijn S van Rijn14, Karijn P M Suijkerbuijk15, Albert J Ten Tije16, Astrid A M van der Veldt17, Gerard Vreugdenhil18, Michiel C T van Zeijl19, Ellen Kapiteijn8, Michel W J M Wouters20. 1. Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: a.jochems@lumc.nl. 2. Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands. 4. Department of Surgical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek hospital, Amsterdam, the Netherlands. 5. Department of Medical Oncology, Zuyderland Medical Center, Sittard, the Netherlands. 6. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands. 7. Department of Medical Oncology, Amsterdam UMC, location VU Medical Center, Amsterdam, the Netherlands. 8. Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands. 9. Isala Oncology Center, Zwolle, the Netherlands. 10. Department of Medical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek hospital, Amsterdam, the Netherlands. 11. Department of Medical Oncology, Groningen University Medical Center, University of Groningen, Groningen, the Netherlands. 12. Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands. 13. Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands. 14. Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. 15. Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. 16. Department of Medical Oncology, Amphia hospital, Breda, the Netherlands. 17. Departments of Medical Oncology and Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. 18. Department of Medical Oncology, Maxima Medical Center, Eindhoven, the Netherlands. 19. Scientific bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands. 20. Department of Surgical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek hospital, Amsterdam, the Netherlands; Scientific bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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.
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.
Authors: Daisy van der Ziel; Marloes G M Derks; Ellen Kapiteijn; Esther Bastiaannet; Marieke Louwman; Frederiek van den Bos; Simon P Mooijaart; Johanneke E A Portielje; Nienke A de Glas Journal: Cancers (Basel) Date: 2022-10-07 Impact factor: 6.575