U. Leiter-Stöppke, S. Ugurel, L. Nanz, P. Mohr, F. Meier, M. Weichenthal, I. von Wasielewski, P. Terheyden, J. Hassel, A. Kreuter, R. Herbst, A. Gesierich, C. Pfoehler, R. Gutzmer, Julia Welzel, C. Gebhardt, S. Haferkamp, J. Ulrich, M. Kaatz, F. Meiß, C. Berking, T. Gambichler, T. Amaral, A. Forschner, E. Livingstone, L. Zimmer, D. Schadendorf, U. Hillen
- Background: In elderly patients with cutaneous melanoma (CM) treatment for primary tumors and advanced stages is often limited due to comorbidities. We analysed the frequency and efficacy of primary treatment and systemic therapy in patients with CM, especially those of immune checkpoint inhibitors (ICI).
Methods: This retrospective multicenter study of the skin cancer registry ADOREG of the German Dermatologic Cooperative Oncology Group included patients diagnosed between 01/2013 and 12/2023 receiving systemic therapy for advanced CM (aCM). Study endpoints were best overall response (BOR), progression-free survival (PFS), melanoma-specific survival (MSS) and ICI-associated side effects.
Results: 8,213 patients from 54 clinical centers with a follow-up time of ≥6 months were included. Patients <75 years were compared to those ≥75 years. The older patient’s group consisted of a higher number of males, comorbidities, CM in sun-exposed areas, lentigo maligna and nodular subtypes,Background: In elderly patients with cutaneous melanoma (CM) treatment for primary tumors and advanced stages is often limited due to comorbidities. We analysed the frequency and efficacy of primary treatment and systemic therapy in patients with CM, especially those of immune checkpoint inhibitors (ICI).
Methods: This retrospective multicenter study of the skin cancer registry ADOREG of the German Dermatologic Cooperative Oncology Group included patients diagnosed between 01/2013 and 12/2023 receiving systemic therapy for advanced CM (aCM). Study endpoints were best overall response (BOR), progression-free survival (PFS), melanoma-specific survival (MSS) and ICI-associated side effects.
Results: 8,213 patients from 54 clinical centers with a follow-up time of ≥6 months were included. Patients <75 years were compared to those ≥75 years. The older patient’s group consisted of a higher number of males, comorbidities, CM in sun-exposed areas, lentigo maligna and nodular subtypes, increased tumor thickness and ulcerated CM (all: p<0.001). Older patients received less SLNB and in aCM, less surgery, radiotherapy and systemic treatment (all: p<0.01). The median number of treatment lines was lower in older patients (1.6 vs 2.1), whereas the treatment with ICI at any line showed no difference. Patients ≥75 years had a worse ECOG status (p<0.001) and received predominantly ICI monotherapy (65.1% vs 36.3%), younger patients received more ICI combination (34.-9% vs 16.2%, p<0.001). Concerning 1st line therapy, no difference was seen for BOR of any kind of treatment (p=0.306), nor under ICI (p=0.202). For ICI, ORR was 25.8% for patients <75 years and 29.5% for those ≥75 years, progressive disease was seen in 35.2% of older patients vs 30.4% of younger patients (p=0.202). Younger patients experienced more frequent and severe side effects with ICI (even mono), while older patients stopped treatment more frequently due to comorbidities and at their own request (p<0.001).
The median follow-up time was longer in patients <75 years (33 vs 26 months, p<0.001). The 3-year MSS was 61% for the group <75 years and 62% for patients ≥75 years (p=0.628).
Conclusions: Patients ≥75 years with aCM received surgery and systemic treatment less often, but started systemic therapy predominantly with ICI (81.5% vs 71.0%). The BOR to ICI did not differ in both groups, toxicity was higher in younger patients, older patients stopped treatment more often due to comorbidities.…
