Pembrolizumab for Unresectable or Metastatic Melanoma in Patients Older than 85 Years of Age

Chanal, J.; Kramkimel, N.; Ratour, Carole; Aractingi, S.; Guégan, Sarah; Avril, Marie-Françoise

doi:10.1159/000492467

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…Median OS treatment-naïve: 38.6, all patients: 23.8 months. ORR treatment-naïve: 52%, all patients: 41% NA Eggermont et al 2018 [ 13 ] Double-blind, phase 3 CT III Pembrolizumab 1019 15.5 NA 12-month rate RFS pembrolizumab: 75.4%, placebo: 61% ( p < 0.001) Chanal et al 2019 [ 14 ] Retrospective, single-center NA Pembrolizumab 9 patients over 85 years old NA OS for stage IV: 8 months NA Lang et al 2018 [ 16 ] Real-life study Stage IIIC or IV Ipilimumab or vemurafenib 80 (40 ipilimumab and 40 vemurafenib) 8 vemurafenib, 10 ipilimumab Median OS vemurafenib: 8, ipilimumab: 10 months. Survival rate beyond 12 months ipilimumab: 42.5%, vemurafenib: 38% NA Drysdale et al 2019 [ 15 ] Population based retrospective study NA Ipilimumab or dacarbazine 464 (298 ipilimumab and 175 dacarbazine) 5.2 dacarbazine, 7 ipilimumab Median OS dacarbazine: 5.2, ipilimumab: 9.5 months.…”

Section: Methodsmentioning

confidence: 99%

“…A monocentric retrospective case series included nine patients with MM over 85 years old [ 14 ]. All patients were treated with pembrolizumab IV (2 mg/kg every 3 weeks).…”

Section: Methodsmentioning

confidence: 99%

“…The OS was 8 months for stage IV patients. Pembrolizumab treatment in patients older than 85 years, even when a reduced number of infusions are delivered, may induce a response, but it may also be associated with a higher risk of toxicity [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

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Looking into a Better Future: Novel Therapies for Metastatic Melanoma

Villani

Scalvenzi

Fabbrocini

et al. 2021

Dermatol Ther (Heidelb)

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Even though melanoma represents a small percentage of all cutaneous cancers, it is responsible for most deaths from skin neoplasms. In early stages it can be successfully treated with surgery, but as the disease expands the survival rate drops significantly. For many years the mainstay of treatment for metastatic melanoma was chemotherapeutic agents, even though they failed to prove survival prolongation. After the advent of ipilimumab, a survival benefit and better overall response rate could be offered to the patients. Other new therapies, such as immunotherapies, targeted therapies, vaccines, and small molecules, are currently being studied. Also, combination regimens have demonstrated superiority to some monotherapies. Nowadays, ipilimumab should no longer be considered the first-line therapy given its severe toxicity and lower efficacy, while nivolumab remains efficacious and has a good safety profile. T-VEC as monotherapy has been shown to be an elegant alternative even for the elderly or cases of head and neck melanomas. If the BRAF mutation status is positive, the combination of dabrafenib and trametinib could be an option to consider. Despite the success of the novel treatments, their effectiveness is still limited. New studies have opened up new avenues for future research in melanoma treatment, which is expected to lead to better therapeutic outcomes for our patients. The objective of this review is to discuss the novel therapies for metastatic melanoma that have been tested in humans during the last 3 years to obtain a sharper perspective of the available treatment options for specific patient characteristics.

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Section: Methodsmentioning

confidence: 99%

“…A monocentric retrospective case series included nine patients with MM over 85 years old [ 14 ]. All patients were treated with pembrolizumab IV (2 mg/kg every 3 weeks).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Looking into a Better Future: Novel Therapies for Metastatic Melanoma

Villani

Scalvenzi

Fabbrocini

et al. 2021

Dermatol Ther (Heidelb)

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“…[ 5 ] In a phase II clinical study (NCT03013101), the objective response rate of patients with advanced melanoma treated with toripalimab was 20.7%, 38.5%, and 11.9% in the overall population and programmed cell death protein ligand 1 (PD-L1) positive and PD-L1 negative subgroups, respectively. [ 5 , 6 ] Many clinical trials evaluating the curative effects of toripalimav alone or in combination with chemotherapy or targeted therapy in various cancers are ongoing. In a case report, a patient with pulmonary sarcomatoid carcinoma progression benefitted from toripalimab combined with local radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

PD-1 inhibitor toripalimab with gemcitabine as a neoadjuvant therapy for muscle-invasive bladder urothelial carcinoma

Yin

Guan

et al. 2022

Medicine

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Rationale: Routine neoadjuvant therapy for muscle-invasive bladder urothelial carcinoma prior to radical surgery is curative. With the increase in cancer immunotherapy, neoadjuvant immunotherapy has been used as an important complement to neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma. Toripalimab is a recombinant, humanized IgG4 monoclonal antibody directed against programmed cell death protein 1 and received the first global approval for the treatment of unresectable or metastatic melanoma in China on December 17, 2018. Patient concerns and diagnosis: A 57-year-old man was admitted to our hospital because of hematuria for 1 week. The patient was diagnosed pathologically with muscle-invasive bladder urothelial carcinoma. Interventions and outcomes: The patient received neoadjuvant toripalimab combined with gemcitabine therapy. The patient showed partial response. Subsequently, radical cystectomy was performed. Lessons: Toripalimab combined with gemcitabine exhibited accurate antitumor activity and may be a promising novel neoadjuvant therapy for muscle-invasive urothelial carcinoma.

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“…12 However, with regard to the occurrence of adverse events, there is some evidence that toxicities might be higher in old and oldest-old patients compared to those reported in clinical trials. [13][14][15][16] Considering that side effects and hospitalization strongly influence the quality of life and the cognitive abilities of old patients, a great need for effective therapies with a low incidence of adverse events remains. 17,18 In 2015 and 2016 T-VEC, a genetically modified herpes simplex virus, was approved in the USA and in Europe for the intratumoral treatment of unresectable cutaneous, subcutaneous and nodal lesions in patients with melanoma.…”

Section: Introductionmentioning

confidence: 99%

Real-World Experience of Talimogene Laherparepvec (T-VEC) in Old and Oldest-Old Patients with Melanoma: A Retrospective Single Center Study

Kleemann¹,

Jäger²,

Valesky³

et al. 2021

CMAR

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Rising melanoma incidences lead to an increasing need for individual therapy strategies in old patients. Talimogene laherparepvec (T-VEC) is a modified herpes simplex virus, approved for the local treatment of unresectable metastatic melanoma. Since data on the efficacy and safety of geriatric patients are sparse, this study was conducted to gain further real-world experience in the treatment of old and oldest-old patients with T-VEC and to obtain data on therapy costs in this population in Germany. Patients and Methods: We performed a retrospective analysis, including all patients with a minimum age of 75 years who were treated with T-VEC from August 2016 to September 2020 in the Skin Cancer Center of the University Hospital Frankfurt, Germany. Patient clinicopathological data, treatment responses, toxicities, treatment-specific data and therapy costs were assessed. Results: Twelve patients with a median age of 83 years (75-89 years) at the start of treatment were identified. By the end of the study, three (25%) patients experienced complete remission (CR), four (33%) experienced partial response (PR), two patients (17%) remained at stable disease (SD) and three (25%) patients suffered from progressive disease (PD). Overall response rate was 58.3%, and durable response rate was 41.7%. There were no treatment-related adverse events grade 3 or higher. The median duration of treatment was seventeen weeks (3-57 weeks). Median medication costs in the patients who had completed treatment (n=10) were calculated to be 27,325 Euros in Germany. Conclusion:This study provides further evidence for an effective use of T-VEC in old and oldest-old patients. The low rate of adverse events seems to be favorable compared to other systemic melanoma therapies. Furthermore, duration of treatment was short and therapy costs were lower than would have been expected from clinical trial data. Altogether, these data encourage the use of T-VEC in this special patient cohort.

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Pembrolizumab for Unresectable or Metastatic Melanoma in Patients Older than 85 Years of Age

Cited by 8 publications

References 15 publications

Looking into a Better Future: Novel Therapies for Metastatic Melanoma

Looking into a Better Future: Novel Therapies for Metastatic Melanoma

PD-1 inhibitor toripalimab with gemcitabine as a neoadjuvant therapy for muscle-invasive bladder urothelial carcinoma

Real-World Experience of Talimogene Laherparepvec (T-VEC) in Old and Oldest-Old Patients with Melanoma: A Retrospective Single Center Study

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