Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki.
Department of Radiology, Helsinki University Hospital, HUS, University of Helsinki, Finland.
Melanoma Res. 2021 Jun 1;31(3):218-223. doi: 10.1097/CMR.0000000000000727.
Although new compounds have improved the treatment landscape of metastatic melanoma, very limited data exist on the efficacy and safety of treating older patients with novel agents. Here, we provide results of BRAF (BRAFi) ± MEK (MEKi) inhibitor treatment in patients over 75 years (oldest-old patients) with metastatic melanoma. Between 2011 and 2020, 34 consecutive patients with metastatic melanoma over 75 years of age (range 75-89) were treated with BRAFi ± MEKi at the Comprehensive Cancer Center of Helsinki University Hospital. Data on clinical and histopathological features, toxicity, response rate (RR), progression-free survival (PFS) and overall survival (OS) were collected. Patients were treated with BRAFi (n = 22) or BRAFi in combination with MEK inhibitor (MEKi) (n = 12). Grade 1-2 adverse events occurred in 68% of the patients, 32% had grade 3 adverse effects, dose reductions were made for 41% of patients and 29% terminated treatment due to toxicity. Overall, the RR was 62%. Complete responses were achieved in 27% of the patients, and 35% had partial responses. The median PFS was 8 months (range 0-57), and the median OS was 15 months (range 0-71). Tailored BRAFi ± MEKi treatment for older patients is feasible. Adverse effects occur frequently but are manageable by dose adjustment. The occurrence of toxicity of monotherapy was similar to that of combination therapy. The RR and median OS from our retrospective study are comparable with those reported in clinical trials and combination therapy produced somewhat more and longer-lasting responses. Hence, it seems that older patients may benefit from BRAFi treatment.
尽管新化合物改善了转移性黑色素瘤的治疗前景，但对于用新型药物治疗老年患者的疗效和安全性，仅有非常有限的数据。在这里，我们提供了 BRAF（BRAFi）±MEK（MEKi）抑制剂治疗 75 岁以上（最年长患者）转移性黑色素瘤患者的结果。在 2011 年至 2020 年期间，34 例连续转移性黑色素瘤患者年龄超过 75 岁（75-89 岁），在赫尔辛基大学医院综合癌症中心接受 BRAFi±MEKi 治疗。收集了临床和组织病理学特征、毒性、缓解率（RR）、无进展生存期（PFS）和总生存期（OS）的数据。患者接受 BRAFi（n=22）或 BRAFi 联合 MEK 抑制剂（MEKi）（n=12）治疗。68%的患者发生 1-2 级不良反应，32%的患者发生 3 级不良反应，41%的患者需要减少剂量，29%的患者因毒性而终止治疗。总的来说，RR 为 62%。27%的患者达到完全缓解，35%的患者部分缓解。中位 PFS 为 8 个月（0-57），中位 OS 为 15 个月（0-71）。为老年患者量身定制的 BRAFi±MEKi 治疗是可行的。不良反应常发生，但通过剂量调整可管理。单药治疗的毒性发生情况与联合治疗相似。我们回顾性研究的 RR 和中位 OS 与临床试验报告的结果相当，联合治疗产生的缓解更持久。因此，老年患者似乎可能从 BRAFi 治疗中获益。
