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Utilization of Real-World Data to Assess the Effectiveness of Immune Checkpoint Inhibitors (ICIs) in Elderly Patients with Metastatic Melanoma

Date

30 Sep 2019

Session

Poster Display session 3

Presenters

D Scott Ernst

Citation

Annals of Oncology (2019) 30 (suppl_5): v533-v563. 10.1093/annonc/mdz255

Authors

D.S. Ernst1, H. McConkey2, L. Liu3, M.O. Butler4, T. Petrella5, T. Baetz6, R. Koneru7, X. Song8, T. Cheng9, M.G. Smylie10, S. Rajagopal11, C. Mihalcioiu12, F. Gwadry-Sridhar13

Author affiliations

  • 1 Department Of Oncology, Western University, N6A3K7 - London/CA
  • 2 Canadian Melanoma Research Network, Global Melanoma Research Network, N6C 2R6 - London/CA
  • 3 Data Analytics, Pulse Infoframe, N5X 4E7 - London/CA
  • 4 Department Of Medical Oncology And Hematology, Princess Margaret Hospital, M5G 2M9 - Toronto/CA
  • 5 Medical Oncology, Sunnybrook Health Sciences Centre - Odette Cancer Centre, M4N 3M5 - Toronto/CA
  • 6 Cancer Centre Of Southeastern Ontario At Kingston General Hospital, Kingston Health Sciences Centre, K7L 5P9 - Kingston/CA
  • 7 Department Of Oncology, Lakeridge Health, L1G2B9 - Oshawa/CA
  • 8 Medical Oncology, University of Ottawa, K1H8M5 - Ottawa/CA
  • 9 Tom Baker Cancer Centre, Alberta Health Services, T2N 4N2 - Calgary/CA
  • 10 Medical Oncology, University of Alberta Cross Cancer Institute, T6G 1Z2 - Edmonton/CA
  • 11 Department Of Oncology, Peel Regional Cancer Centre, Credit Valley Hospital, L5M 2N1 - Mississauga/CA
  • 12 Medical Oncology, McGill University Health Centre - Glen Site, H4A 3J1 - Montreal/CA
  • 13 Computer Science, University of Western Ontario, London/CA
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Resources

Abstract 5524

Background

The widespread introduction of ICIs in patients (pts) with metastatic disease has significantly improved outcomes. However, ICIs in the elderly requires further evaluation to determine whether outcomes differ from that observed in younger cohorts. The goal of this study is to utilize real-world data from the Canadian Melanoma Research Network Registry.

Methods

This retrospective observational study was performed in metastatic pts entered into a common clinical registry and who received ipilimumab alone (ipi) and nivolumab (nivo) or pembrolizumab (pembro) from 2008 to February 2019. Demographics, extent of disease, all treatments and adverse events (AEs) were compiled. Comparisons between pts in different age cohorts were made. The potential impact of known prognostic factors was investigated using Cox proportional multivariate analyses.

Results

144 pts over 70 were treated with ICI as 1st line. 43 patients received ipi and 101 received nivo or pembro. BRAF mutation was present in 17%. Pulmonary mets: 56%; Liver mets 34%; Brain mets: 16%. For those aged 70-99, median survival was 10 M (range: 1 M - 50 M). In a comparative cohort of pts aged 50-69, the median survival was 11.8 M (range: 1 M – 78 M). On multivariate analysis age, baseline LDH and BRAF status did not impact overall survival. Within the elderly cohort, the use of ipi was associated with significantly decreased overall survival when compared to nivo and pembro (OS ipi: 6.8 M vs anti-PD1: 10.6 M). 95 pts over 70 received ICIs as 2nd line, with a median survival of 6.3 M, which was not significantly different from the younger cohort who received second-line ICIs (median survival of 8 M). In the elderly cohort, 124 >grade 2 AEs were observed: Rash 25%; Colitis: 18%; Fatigue: 8%; Asthenia: 7%.

Conclusions

ICIs can be effectively utilized in pts over 70. Survival appears to be comparable to that achieved in younger cohorts. Elderly pts who only received ipi appeared to have a worse outcome than those pts who received nivo or pembro.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Global Melanoma Research Network.

Funding

Global Melanoma Research Network.

Disclosure

All authors have declared no conflicts of interest.

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