Immunotherapy in Older Patients with Advanced Melanoma: A Review of the Current Evidence

Foo, Tiffany; Rico, Gonzalo Tapia; Roberts‐Thomson, Rachel

doi:10.1007/s40266-020-00762-1

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…At present, anti-PD-1 monotherapy, or combined with anti-CTLA-4 inhibition, both represent first-line treatment options for patients with metastatic melanoma. In elderly patients with metastatic melanoma with relevant comorbidities, anti-PD-1 monotherapy may be favored in elderly and multimorbid patients due to the toxicity of combined immunotherapy [9].…”

Section: Introductionmentioning

confidence: 99%

Low-dose ipilimumab combined with anti-PD-1 immunotherapy in patients with metastatic melanoma following anti-PD-1 treatment failure

et al. 2021

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Combined immunotherapy is associated with a significant risk of severe and potentially fatal immune-related adverse events (irAEs). Therefore, we retrospectively analyzed the side profile and efficacy of low-dose ipilimumab (1 mg/ kg, IPI1) combined with anti-PD-1 immunotherapy in patients who progressed after anti-PD-1 monotherapy. Nine patients with unresectable stage III or IV melanoma treated with combined low-dose ipilimumab (1 mg/ kg, IPI1) and anti-PD-1 immunotherapy, following progression after anti-PD-1 treatment, were identified. Treatment response and irAEs were recorded. Grade 3 irAEs occurred in one-third of patients. Interestingly, there were no grade 4 or 5 irAEs. In fact, four out of the nine patients experienced no irAEs at all. One patient discontinued combined immunotherapy due to immunerelated colitis. The mean time to the onset of grade 3 irAEs was 14.3 weeks. The objective response rate was 33.3% and a disease control rate of 66.7% was achieved. Median progression-free survival (PFS) was 5.7 months and median overall survival (OS) was 21.6 months. The median PFS when IPI1 and anti-PD-1 treatment was administered in the second-line setting was not reached, but only 2.8 months when used in subsequent treatment settings. Combined IPI1 and anti-PD-1 immunotherapy was well tolerated. Its use in the third-line or above setting was associated with a significantly poorer prognosis than in the second-line setting. Larger, prospective studies are required to evaluate the safety and efficacy of this dosing regimen following anti-PD-1 treatment failure. Melanoma Res 31: 464

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Section: Introductionmentioning

confidence: 99%

Low-dose ipilimumab combined with anti-PD-1 immunotherapy in patients with metastatic melanoma following anti-PD-1 treatment failure

et al. 2021

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Predicting treatment toxicity in older adults with cancer

Menjak

Mata

Chesney

et al. 2021

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review To provide an overview of the recent advancements in predicting toxicity associated with cancer treatment in older patients. Recent findings Various screening tools and validated risk calculators have been shown to help predict toxicity from surgery and chemotherapy. Radiation therapy has been more challenging to select the appropriate tool to reliably predict patients at risk for toxicity and noncompliance. Ongoing work on electronic geriatric assessment tools is showing promise in making comprehensive assessment more feasible. Summary Selecting appropriate cancer therapy is particularly important in older patients, and validated tools have been developed to guide clinicians for surgery and chemotherapy; however, radiotherapy toxicity remains an area for further development, as does the uptake of existing tools into routine oncology practice.

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Complete response to immunotherapy in a nonagenarian patient with metastatic melanoma

2020

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Despite the increasing incidence of metastatic melanoma in the older population, there are relatively limited data for those older than 75 years of age. Elderly patients are often under-represented in clinical trials. In addition, elderly patients in trials often have a lower Eastern Cooperative Oncology Group score and fewer comorbidities and may thus not truly reflect the realities of day-to-day clinical practice. We present a case of a 95-year-old woman who had extensive and unresectable subcutaneous and dermal deposits of metastatic melanoma of her right leg, which caused oedema and reduced mobility. She was treated concurrently with pembrolizumab and radiotherapy to her leg lesions of melanoma. She has had an excellent response to treatment, with complete resolution of the subcutaneous and dermal metastatic deposits and has not developed any immune-related toxicities. Our experience demonstrates that anti-programmed-death-receptor-1 therapy can be given safely and effectively even in very elderly metastatic melanoma patients.

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Immunotherapy in Older Patients with Advanced Melanoma: A Review of the Current Evidence

Cited by 3 publications

References 38 publications

Low-dose ipilimumab combined with anti-PD-1 immunotherapy in patients with metastatic melanoma following anti-PD-1 treatment failure

Low-dose ipilimumab combined with anti-PD-1 immunotherapy in patients with metastatic melanoma following anti-PD-1 treatment failure

Predicting treatment toxicity in older adults with cancer

Complete response to immunotherapy in a nonagenarian patient with metastatic melanoma

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