年龄与免疫疗法治疗转移性黑色素瘤疗效的关系。
Association of Age with Efficacy of Immunotherapy in Metastatic Melanoma.
机构信息
Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Oncologist. 2020 Feb;25(2):e381-e385. doi: 10.1634/theoncologist.2019-0377. Epub 2019 Oct 29.
Management of melanoma has been revolutionized by the use of immune checkpoint inhibitors. Immune system changes associated with aging may affect the efficacy of immune-based therapies. Using the National Cancer Database, we evaluated the impact of age on the receipt and efficacy of modern immunotherapies in patients with metastatic melanoma. We identified 11,944 patients from 2011-2015, of whom 25% received immunotherapy. Older (≥60 years), compared with younger, patients were less likely to receive immunotherapy (odds ratio, 0.69; 95% confidence interval [CI], 0.61-0.78; p < .001). Immunotherapy was associated with a survival benefit in both younger and older patients (<60 years: hazard ratio [HR], 0.64; 95% CI, 0.57-0.72; p < .001; ≥60 years: HR, 0.55; 95% CI, 0.50-0.60; p < .001). Importantly, there was a statistically significant interaction between age and survival with immunotherapy, where a greater benefit was observed for older patients (p = 0.013). Further work studying the age-related response to immunotherapy is warranted.
免疫检查点抑制剂的使用彻底改变了黑色素瘤的治疗模式。与衰老相关的免疫系统变化可能会影响基于免疫的治疗的疗效。我们使用国家癌症数据库,评估了年龄对转移性黑色素瘤患者接受现代免疫疗法和疗效的影响。我们从 2011 年至 2015 年确定了 11944 名患者,其中 25%接受了免疫治疗。与年轻患者相比,年龄较大(≥60 岁)的患者接受免疫治疗的可能性较小(优势比,0.69;95%置信区间,0.61-0.78;p<0.001)。免疫治疗在年轻和老年患者中均与生存获益相关(<60 岁:风险比 [HR],0.64;95%置信区间,0.57-0.72;p<0.001;≥60 岁:HR,0.55;95%置信区间,0.50-0.60;p<0.001)。重要的是,年龄与免疫治疗的生存之间存在统计学显著的交互作用,老年患者的获益更大(p=0.013)。需要进一步研究年龄相关的免疫治疗反应。