Cybulska-Stopa Bożena, Ługowska Iwona, Jagodzińska-Mucha Paulina, Koseła-Paterczyk Hanna, Kozak Katarzyna, Klimczak Anna, Świtaj Tomasz, Ziobro Marek, Roman Agnieszka, Rajczykowski Marcin, Suwiński Rafał, Niemiec Maciej, Zemełka Tomasz, Falkowski Sławomir, Rutkowski Piotr
Clinical Oncology Clinic, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Poland.
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland.
Postepy Dermatol Alergol. 2019 Oct;36(5):566-571. doi: 10.5114/ada.2018.79940. Epub 2019 Nov 12.
The use of immunotherapy in older patients remains challenging due to very few data on the efficacy and safety of treatment in this group.
To analyse the efficacy and safety of immunotherapy with checkpoint inhibitors in older patients (≥ 70 years) with metastatic melanoma.
In the Maria Skłodowska-Curie Institute - Oncology Centre, between 2011 and 2017, 318 non-resectable or metastatic melanoma patients were treated with immune checkpoint inhibitors: anti-CTLA-4 or/and anti-PD-1. Eighty-two patients were ≥ 70 years (median age: 76 years; range: 70-90 years). Among this group 10% of patients had brain metastases, 24% of patients had BRAF mutant melanoma, and co-morbidities were present in 86% of patients (mainly hypertension, cardiovascular diseases and/or diabetes).
Median PFS and OS were similar in patients < 70 years and ≥ 70 years. In the group of patients ≥ 70 years old, the 2-year OS rate (from the start of immunotherapy) was 27%, and in patients aged < 70 it was 28% ( = NS). Two-year progression-free survival was 13.7% in the group of patients ≥ 70 years old and in patients aged < 70 it was 13% ( = NS). Patients ≥ 70 years of age were significantly less likely to have a mutation ( = 0.020). The presence of co-morbidities was not associated with an increased risk of immunotherapy ( = 0.790).
The survival and toxicity profile in the older patients treated with immune checkpoint inhibitors are similar to younger patients. Therefore, the age as a clinical factor should not exclude this population from the most effective therapy used nowadays in melanoma treatment.
由于关于免疫疗法在老年患者中的疗效和安全性的数据非常少，因此在老年患者中使用免疫疗法仍然具有挑战性。
分析在老年（≥70岁）转移性黑色素瘤患者中使用检查点抑制剂进行免疫治疗的疗效和安全性。
在玛丽亚·斯克洛多夫斯卡-居里研究所肿瘤中心，2011年至2017年间，318例不可切除或转移性黑色素瘤患者接受了免疫检查点抑制剂治疗：抗CTLA-4或/和抗PD-1。82例患者年龄≥70岁（中位年龄：76岁；范围：70-90岁）。在该组患者中，10%的患者有脑转移，24%的患者有BRAF突变型黑色素瘤，86%的患者有合并症（主要是高血压、心血管疾病和/或糖尿病）。
年龄<70岁和≥70岁的患者的中位无进展生存期（PFS）和总生存期（OS）相似。在≥70岁的患者组中，2年总生存率（从免疫治疗开始）为27%，而年龄<70岁的患者为28%（P=无显著性差异）。≥70岁的患者组的2年无进展生存率为13.7%，年龄<70岁的患者为13%（P=无显著性差异）。≥70岁的患者发生 突变的可能性显著更低（P=0.020）。合并症的存在与免疫治疗风险增加无关（P=0.790）。
接受免疫检查点抑制剂治疗的老年患者的生存和毒性特征与年轻患者相似。因此，年龄作为一个临床因素不应将该人群排除在目前黑色素瘤治疗中最有效的治疗方法之外。
