Systemic treatment for metastatic melanoma might be beneficial in older patients

Systemic melanoma treatment does not lead to increased toxicity in older adults and may yield slight survival benefits, a recent study has found. Nevertheless, death from causes other than melanoma contributes to a lower overall survival (OS) in older patients.

The researchers enrolled a real-world cohort of 3,054 patients with metastatic melanoma who were categorized according to age: ≤65 years (n=1,595, 56.4 percent men), 66–74 years (n=896, 63.4 percent men), and ≥75 years (n=563, 60.4 percent men). Data were retrieved from the Dutch Melanoma Treatment Registry and analysed for OS, melanoma-specific survival (MSS), and mortality risks.

Over a median follow-up of 211 days, survival differences emerged between age groups. The 3-year OS rate in patients aged ≥75 years was 13.7 percent, as opposed to 26.7 percent in those aged ≤65 years.

Adjusted Cox proportional hazard analysis revealed that the oldest subgroup was more than 50-percent more likely to die of all causes than the youngest subgroup (adjusted hazard ratio [HR], 1.53, 95 percent confidence interval [CI], 1.30–1.80; p<0.001).

However, death due to melanoma was comparable, with 3-year MSS rates of 30.4 percent and 43.0 percent in patients aged ≥75 years and ≤65 years, respectively (adjusted HR, 1.21, 95 percent CI, 1.00–1.47; p=0.049). This discrepancy between OS and MSS points to the competing risk of death due to causes other than metastatic melanoma in the oldest subgroup, the researchers said.

Systemic treatment was comparably safe across age groups, with grade 3 or 4 adverse events occurring at similar rates. The most common adverse events were of dermatologic origin, such as rashes, hyperkeratosis, and photosensitivity.

“Together with known literature, our study emphasizes that age should not be used as a specific criterion to withhold treatment to patients with metastatic melanoma. The role for geriatric assessment needs to be strongly considered for better risk stratification of patients and avoid unnecessary treatment for frail patients, as well as holding treatment for fitter patients,” the researchers said.