Immunotherapy comes of age in octagenarian and nonagenarian metastatic melanoma patients

Immunotherapy with anti–programmed cell death-1 (PD-1) agents is an effective treatment for metastatic melanoma. Recent data hint at better response to therapy for patients over age 65 years. Patients with metastatic melanoma in their 80's and 90's pose a clinical challenge. We describe a cohort of 144 patients ≥65 years and analyse the efficacy and toxicity of anti–PD-1 therapy in ages 80–100 years compared with ages 65–79 years. Records of metastatic melanoma patients aged 65–100 years treated with anti–PD-1 were collected retrospectively. Baseline parameters, response rate (overall response rate [ORR]), best response, progression-free survival (PFS) and overall survival (OS) and immune-related adverse events were analysed. Cox regression, t test, and chi-square test were used for statistical analysis. Five hundred patients were treated with anti–PD-1 agents between 2013 and 2018.Eighty-two patients were aged 65–79 years (group A, median 71.5 years), and 62 patients were aged 80–100 years (group B, median 84 years, range 80–97 years). Baseline parameters were comparable except for worse PS in group B (p = 0.001). One hundred twenty-four patients were evaluable for analysis of response (76 group A, 48 group B). A trend was noted for higher ORR in the older group with 62.3% for group A and 73.9% for group B (p = 0.09). Complete response was significantly higher in group B versus group A (47.9% versus 20%, p = 0.001). No significant difference was found in PFS or OS between the groups. Toxicity for all patients was similar at 22.8%–25.6% G2-4 adverse events. Elderly patients show enhanced response to anti–PD-1 therapy. Increasing age within the elderly patients group may predict an even better response to therapy and comparable survival in patients of very old age.