Medical Oncology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Medical Oncology Department, Gold Coast University Hospital, Southport, Queensland, Australia.
Pigment Cell Melanoma Res. 2022 Nov;35(6):587-594. doi: 10.1111/pcmr.13063. Epub 2022 Sep 14.
Combination immunotherapy with nivolumab and ipilimumab is an effective therapy in the treatment of metastatic melanoma, however, its benefit in older patients is unclear. A multicentre retrospective study was performed to compare the efficacy and toxicity of combination immunotherapy in metastatic melanoma in patients ≥65 years versus <65 years, and complications of steroids used to manage toxicity. One hundred and thirty-nine patients were included with 52 patients ≥65 years (median age: 70; range: 65-83) and 87 patients <65 years (median age: 52; range: 22-64). Median overall survival was similar in patients ≥65 years versus <65 years (14.9 vs. 17.3 months p = .58). Median progression-free survival was also similar in both groups (7.1 vs. 6.9 months p = .79), as was overall response rate (48.1% vs. 44.8% p = .73). Age was not associated with a difference in overall survival on multivariate analysis. There was similar rates of Grade 3 or higher adverse events in patients ≥65 years versus <65 years (50% vs. 49% p = 1.0) and discontinuation rates secondary to toxicity (55.8% vs. 56% p = 1.0). Median duration of steroids used to treat adverse events was similar (11 vs. 12 weeks p = .46). Complications of steroids requiring inpatient admission was numerically higher in the older patients (41.3% vs. 20.4% p = .07). Patients ≥65 years received similar benefit from combination immunotherapy in comparison to their younger counterparts with similar toxicity.
纳武利尤单抗和伊匹单抗联合免疫疗法是治疗转移性黑色素瘤的有效疗法，但其在老年患者中的益处尚不清楚。一项多中心回顾性研究比较了 65 岁及以上与 <65 岁转移性黑色素瘤患者联合免疫治疗的疗效和毒性，以及类固醇用于治疗毒性的并发症。共纳入 139 例患者，其中 52 例患者年龄≥65 岁（中位年龄：70 岁；范围：65-83 岁），87 例患者年龄 <65 岁（中位年龄：52 岁；范围：22-64 岁）。65 岁及以上患者与 <65 岁患者的中位总生存期相似（14.9 与 17.3 个月，p=0.58）。两组患者的中位无进展生存期也相似（7.1 与 6.9 个月，p=0.79），总缓解率也相似（48.1%与 44.8%，p=0.73）。多变量分析显示，年龄与总生存期无差异。65 岁及以上患者与 <65 岁患者发生 3 级或更高不良事件的比例相似（50%与 49%，p=1.0），因毒性而停药的比例也相似（55.8%与 56%，p=1.0）。用于治疗不良事件的类固醇中位使用时间相似（11 与 12 周，p=0.46）。类固醇相关并发症需要住院治疗的老年患者比例略高于年轻患者（41.3%与 20.4%，p=0.07）。与年轻患者相比，65 岁及以上的患者从联合免疫治疗中获得了相似的获益，且毒性相似。
