Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
J Geriatr Oncol. 2021 Sep;12(7):1031-1038. doi: 10.1016/j.jgo.2021.04.006. Epub 2021 May 19.
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.
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).
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.
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.
转移性黑色素瘤在各年龄段的发病率都在增加。多项靶向药物和免疫检查点抑制剂的临床试验表明，转移性黑色素瘤患者的生存率得到了提高。然而，年龄≥75 岁的患者在临床试验中往往代表性不足，因此对治疗的安全性和有效性提出了质疑。
我们分析了 3054 例转移性黑色素瘤患者的真实队列，根据年龄（≤65 岁、66-74 岁和≥75 岁）和 BRAF 状态进行分层，提供了治疗策略、毒性和生存数据。Kaplan-Meier 曲线和 Cox 比例风险模型用于呈现总生存期（OS）和黑色素瘤特异性生存期（MSS）。
总体而言，52.2%的患者≤65 岁，18.4%的患者≥75 岁。在≥75 岁的患者中，BRAF 突变肿瘤较少见：≤65 岁的患者为 65%，而≥75 岁的患者为 34.5%。无论 BRAF 状态如何，≥75 岁的患者接受系统治疗的频率均低于年轻患者。在接受治疗时，未观察到 3 级或 4 级毒性的统计学显著差异。≥75 岁患者的 3 年总生存率为 13.7%（9.1-19.3），而≤65 岁患者为 26.7%（23.1-30.4），风险比（HR）为 1.71（95%CI 1.50-1.95），p<0.001。3 年黑色素瘤特异性生存率为 30.4%（22.0-39.2）与 34.0%（29.7-38.2），HR 为 1.26（95%CI 1.07-1.49），p=0.005，调整后的 HR 为 1.21（1.00-1.47），p=0.049。
年龄≥75 岁的转移性黑色素瘤患者接受治疗的频率较低，但在接受治疗时，毒性没有统计学显著增加，仅在黑色素瘤特异性生存方面观察到边缘统计学显著差异，与年轻患者相比。
