1113PD - Safety and efficacy of anti-PD-1 antibodies in elderly patients with metastatic melanoma

Date 10 October 2016
Event ESMO 2016 Congress
Session Melanoma and other skin tumours
Topics Geriatric Oncology
Immunotherapy
Skin cancers
Melanoma
Therapy
Presenter Rajat Rai
Citation Annals of Oncology (2016) 27 (6): 379-400. 10.1093/annonc/mdw379
Authors R. Rai1, J.L. McQuade2, D.Y. Wang3, J.J. Park4, K. Nahar1, J.A. Sosman5, K.E. Beckermann6, L.E. Haydu2, S. Lo1, S. Rubinstein3, K.E. Beckermann3, M. McKean2, S. Matthew3, A. Guminski1, M.S. Carlino4, M. Davies2, D.B. Johnson3, G.V. Long1, A.M. Menzies1
  • 1Medical Oncology, Melanoma Institute Australia, University of Sydney, 2060 - North Sydney/AU
  • 2Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 77030 - Houston/US
  • 3Medicine (hematology-oncology), Vanderbilt University, 37232 - Nashville/US
  • 4Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, 2145 - Sydney/AU
  • 5Medicine (hematology-oncology), Vanderbilt University, Nashville/US
  • 6Medicine (hematology-oncology), Vanderbilt University, 37215 - Nashville/US

Abstract

Background

The incidence of melanoma increases with age. Anti-PD-1 antibodies are often the first option for elderly patients with metastatic melanoma, particularly given the low rate of BRAF mutations in this group, however there are limited data regarding their safety and efficacy.

Methods

All patients treated with anti-PD-1/L1 antibodies on clinical trials at 4 centres were retrospectively identified. Patient demographics, primary and metastatic melanoma characteristics, toxicity, response and survival data were collected. Statistical comparisons were made between older (>75 yrs) and younger (≤75 yrs) patients.

Results

283 patients were included in the analysis, median follow-up of 44.5 months. 208 had pembrolizumab and 71 had nivolumab. Median age was 62 (range 22-87). The cohort had typical prognostic features (75% AJCC stage M1c, 57% ECOG PS 0, 40% elevated LDH, 14% treated stable brain metastases). 124 (43%) had prior ipilimumab, and 63 (22%) prior MAPK inhibitors. 35 (12%) pts were >75 yrs old, and they had similar prognostic features as those ≤75yrs, similar rates of prior ipilimumab, but less prior MAPK inhibitors (2/35 [6%] vs 61/256 [24%], P = 0.04). The objective response rate in pts >75 was similar to pts ≤75 (17/35 [48%] and 89/256 [34%], respectively. There was no difference in the incidence of immune-related adverse events in those >75 than those ≤75 (14/35, [40%] and 95/256, [37%], p > 0.05), and the rates of discontinuation for toxicity were similar (0.05% and 0.05%, p > 0.05). Median PFS and OS was similar in older (8.7 months and 33.5 months) and younger (4.6months and 48.1m onths) patients (P = 0.48). Updated analysis including efficacy associations with primary melanoma features and blood parameters at baseline and early during treatment across the whole cohort will be presented.

Conclusions

Anti-PD-1 antibodies are safe and effective in elderly patients, with response and toxicity profiles similar to that observed in younger patients.

Clinical trial identification

Not applicable

Legal entity responsible for the study

Royal Prince Alfred HREC

Funding

Academic group

Disclosure

A. Guminski: Advisory board member: Pfizer, BMS. M.S. Carlino: Advisory board member for MSD, BMS, Amgen, Novartis. Honoraria: MSD, BMS, Novartis. M. Davies: Advisory board: Novartis, GlaxoSmithKline, Genetech, Sanofi-Aventis, Vaccinex Reseasrh funding: Glaxosmithkline, Genentech, Astazaneca, Oncothyreon, Sanofi-Aventis. D.B. Johnson: Advisory board: BMS, Genoptix. G.V. Long: Consultant advisor to BMS, Merck, MSD, Amgen, Novartis. Honoraria for Merck, BMS and Novartis. A.M. Menzies: Advisory board MSD, Chugai. Honoraria – BMS, Novartis. All other authors have declared no conflicts of interest.