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Faour E, Guo S, Puts M. Geriatric Assessment in the Era of Targeted and Immunotherapy. Drugs Aging 2024; 41:577-582. [PMID: 38914823 DOI: 10.1007/s40266-024-01126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Abstract
Cancer is a disease that mostly affects older adults and because of the aging of the population, the number of older adults diagnosed with cancer will increase significantly around the world. With increasing age, more older adults are living with frailty, and this may impact the tolerability of cancer treatments. International guidelines, such as the American Society for Clinical Oncology geriatric oncology guideline, recommend a geriatric assessment and management for all older adults with cancer to support the treatment decision-making process as well as develop a plan for supportive care interventions to support the older adults during cancer treatments. While there is clinical trial evidence to support a geriatric assessment and management for older adults receiving chemotherapy, there is less evidence to support a geriatric assessment for older adults starting immunotherapy. There are increasing numbers of new immunotherapies and targeted therapies available for older adults with cancer but often few older adults have been included in the clinical trials, leaving less evidence for clinicians to guide treatment decisions. In this current opinion, we review the current evidence on the use of a geriatric assessment and management in the context of immunotherapy and targeted therapy. We review how a geriatric assessment could support older adults making treatment decisions for immunotherapy, review how geriatric assessment parameters are linked with outcomes and provide guidance on how geriatric assessment can guide the supportive care plan during immunotherapy treatment.
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Liang X, Zhang J, Zhang C, Zhai H, Yang P, Chen M. Mesoporous silica coated spicules for photodynamic therapy of metastatic melanoma. J Nanobiotechnology 2024; 22:179. [PMID: 38616270 PMCID: PMC11017598 DOI: 10.1186/s12951-024-02471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024] Open
Abstract
We report on the fabrication of mesoporous silicon dioxide coated Haliclona sp. spicules (mSHS) to enhance the delivery of the insoluble photosensitizer protoporphyrin IX (PpIX) into deep skin layers and mediate photodynamic therapy for metastatic melanoma in mice. The mSHS are dispersed sharp edged and rod-like micro-particles with a length of approximate 143.6 ± 6.4 μm and a specific surface area of 14.9 ± 3.4 m2/g. The mSHS can be topically applied to the skin, adapting to any desired skin area and lesion site. The insoluble PpIX were incorporated into the mesoporous silica coating layers of mSHS (mSHS@PpIX) with the maximum PpIX loading capacity of 120.3 ± 3.8 μg/mg. The mSHS@PpIX significantly enhanced the deposition of PpIX in the viable epidermis (5.1 ± 0.4 μg/cm2) and in the dermis (0.5 ± 0.2 μg/cm2), which was 154 ± 11-fold and 22 ± tenfold higher than those achieved by SHS, respectively. Topical delivery of PpIX using mSHS (mSHS@PpIX) completely eradicated the primary melanoma in mice in 10 days without recurrence or metastasis over 60 days. These results demonstrate that mSHS can be a promising topical drug delivery platform for the treatment of diverse cutaneous diseases, such as metastatic melanoma.
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Affiliation(s)
- Xuejiao Liang
- Department of Marine Biological Science & Technology, College of Ocean and Earth Sciences, Xiamen University, Xiamen, 361102, China
- State-Province Joint Engineering Laboratory of Marine Bioproducts and Technology, Xiamen University, Xiamen, 361102, China
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
| | - Jialiang Zhang
- Fujian Key Laboratory of Advanced Technology for Cancer Screening and Early Diagnosis, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, People's Republic of China
| | - Chi Zhang
- Department of Marine Biological Science & Technology, College of Ocean and Earth Sciences, Xiamen University, Xiamen, 361102, China
- State-Province Joint Engineering Laboratory of Marine Bioproducts and Technology, Xiamen University, Xiamen, 361102, China
| | - Haojie Zhai
- Department of Marine Biological Science & Technology, College of Ocean and Earth Sciences, Xiamen University, Xiamen, 361102, China
- State-Province Joint Engineering Laboratory of Marine Bioproducts and Technology, Xiamen University, Xiamen, 361102, China
| | - Ping Yang
- Department of Marine Biological Science & Technology, College of Ocean and Earth Sciences, Xiamen University, Xiamen, 361102, China
- State-Province Joint Engineering Laboratory of Marine Bioproducts and Technology, Xiamen University, Xiamen, 361102, China
| | - Ming Chen
- Department of Marine Biological Science & Technology, College of Ocean and Earth Sciences, Xiamen University, Xiamen, 361102, China.
- State-Province Joint Engineering Laboratory of Marine Bioproducts and Technology, Xiamen University, Xiamen, 361102, China.
- Shenzhen Research Institute of Xiamen University, Shenzhen, 518000, China.
- Pingtan Research Institute of Xiamen University, Pingtan, 350400, China.
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Segura S, Podlipnik S, Boada A, Martí RM, Sabat M, Yélamos O, Zarzoso-Muñoz I, Azón-Masoliver A, López-Castillo D, Solà J, Baliu-Piqué C, Galvany-Rossell L, Pasquali P, Just-Sarobé M, Duran X, Carrera C, Richarz NA, Pujol RM, Malvehy J, Puig S. Melanoma-specific survival is worse in the elderly: a multicentric cohort study. Melanoma Res 2023; 33:532-538. [PMID: 37696262 DOI: 10.1097/cmr.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
We aimed to characterise cutaneous melanoma in the elderly and determine its association with poorer prognosis. We studied a prospective cohort of the melanoma population in Catalonia between 2012 and 2016. We compared young patient group (<75 years old) with elderly patient group (≥75 years old). We included 3009 patients (52.5% women) from 14 centres, with a mean age at diagnosis of 61.1 years. In the ≥75-year-old group there was a predominance of men (53.9% vs. 45.5%, P < 0.001), melanoma was more frequently located in the head and neck area (37.7% vs. 15.5%, P < 0.001) and lentigo maligna melanoma subtype was significantly more frequent (31.4% vs. 11.6%, P < 0.001), as were nodular melanoma and acral lentiginous melanoma ( P < 0.001). In older people, Breslow index, the presence of ulceration and mitotic rate were higher than in younger people. Kaplan-Meier survival curves showed longer melanoma-specific survival (MSS) and melanoma-free survival (MFS) in <75-year-old group compared to the elderly group. Cox regression models demonstrated reduced MSS in patients ≥75 years regardless of gender, location, IB, ulceration and lymph node status at diagnosis (HR 1.54, P = 0.013) whereas MFS was not independently associated with elderly when head and neck location was considered. Age appears to be an independent risk factor for MSS but not for MFS. Worse melanoma prognosis in elderly could be explained by factors unrelated to the tumour, such as age-related frailty and comorbidities that limit the access to systemic treatments and, eventually, age-related immune dysfunction.
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Affiliation(s)
- Sonia Segura
- Dermatology Department, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona
- Universitat de Vic-Universitat Central de Catalunya (UVIC), Vic
| | - Sebastian Podlipnik
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
| | - Aram Boada
- Dermatology Department, Hospital Germans Trias i Pujol de Badalona, Badalona
| | - Rosa M Martí
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida and Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III
| | - Mireia Sabat
- Dermatology Department, Hospital Universitari Parc Taulí, Sabadell
| | - Oriol Yélamos
- Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona
| | | | | | - Daniel López-Castillo
- Dermatology Department Consorci Sanitari Integral Hospital Moises Broggi, Sant Joan Despí
| | - Joaquim Solà
- Dermatology Department, Hospital General de Granollers, Granollers
| | | | | | - Paola Pasquali
- Dermatology Department, Pius Hospital de Valls, Valls and Universidad de Alcalá, Alcalá de Henares
| | | | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona
| | - Cristina Carrera
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
| | - Nina A Richarz
- Dermatology Department, Hospital Germans Trias i Pujol de Badalona, Badalona
| | - Ramon M Pujol
- Dermatology Department, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
| | - Susana Puig
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, IDIBAPS, Barcelona and CIBERER, Instituto de Salud Carlos III
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Stoff R, Grynberg S, Asher N, Laks S, Steinberg Y, Schachter J, Shapira-Frommer R, Ben-Betzalel G. Efficacy and toxicity of Ipilimumab-Nivolumab combination therapy in elderly metastatic melanoma patients. Front Oncol 2022; 12:1020058. [PMID: 36419899 PMCID: PMC9676931 DOI: 10.3389/fonc.2022.1020058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Immunotherapy has revolutionized metastatic Melanoma therapy. The most active regimen is combination therapy of Ipilimumab-Nivolumab (Ipi-Nivo) with response rates (RR) of ~60% and median overall survival (OS) of ~6 years. Immune-related adverse events (irAE) are common (~60% develop grade 3-4) and pose a challenge when treating frail patients. We sought to examine whether Ipi-Nivo therapy is feasible in elderly metastatic melanoma patients. Methods Electronic records of patients treated at the Ella Lemelbaum Institute with Ipi-Nivo between the years 2017-2021 were screened for age. Elderly patients were defined as age 75 and older (group A) and were matched with records of patients age <75 (group B). Records were analyzed for baseline parameters, immunotherapy regimen, RR, toxicity and progression-free survival (PFS). Results Twenty-six relevant patients age >75 (median 77) were identified and were matched to 34 younger patients (median age 57). No statistically significant differences were noted in terms of baseline parameters except for BRAF mutation status (group A 15%, group B 47%, p=0.008). Response rate in group A was 38% and is consistent with previously published data. Median PFS was the same for both groups (A = 5.5 months, B= 7.5 months, p=NS). Treatment was similarly tolerated: 35% of group A patients completed 4 cycles of therapy compared to 28% for group B (p=NS). Grade 2-4 irAE were the same (A=58%, B=66%, p=NS) and there was no difference in the need for hospitalization for G3-4 events between the groups. (A=63%, B=69%, p=NS). Further division into 4 age groups (>80 vs 75-79 in group A and 65-74 vs <65 in group B) found no difference in terms of response rate or G3-4 toxicity. Conclusion Ipilimumab-Nivolumab combination therapy in elderly metastatic Melanoma patients seems to be well tolerated and efficient in selected elderly patients based on performance status and comorbidities, just as in younger patients. This regimen seems to be a feasible treatment option for this age group.
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Affiliation(s)
- Ronen Stoff
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
- *Correspondence: Ronen Stoff, ; Shirly Grynberg,
| | - Shirly Grynberg
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
- *Correspondence: Ronen Stoff, ; Shirly Grynberg,
| | - Nethanel Asher
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Shachar Laks
- Surgical Division, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Steinberg
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Schachter
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
| | | | - Guy Ben-Betzalel
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
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Benguerfi S, Lesimple T, Houot R, Ricordel C, Legoupil D, Alleaume C, Lamy R, Deniel Lagadec D, Corre R. Immune checkpoint inhibitors in patients aged 80 or older with advanced non-small cell lung cancer or melanoma: a real-life multicentre study. Acta Oncol 2022; 61:1339-1346. [PMID: 36239950 DOI: 10.1080/0284186x.2022.2132114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data regarding characteristics, safety and survival outcomes of patients aged 80 or older treated with immune checkpoint inhibitors (ICI) in routine oncology practice are limited. MATERIALS AND METHODS We retrospectively collected data of patients aged 80 and older with advanced non-small cell lung cancer (NSCLC) or melanoma treated with anti-PD1, anti-PD-L1 or anti-CTLA-4 regardless of the treatment line, in 14 institutions, between January 2014 and June 2017. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan Meier method. Toxicity was assessed according to CTCAE 5.0. Multivariate analyses were performed with the Cox model. RESULTS Eighty-two patients were included (36 with NSCLC, 45 with melanoma). Their median age was 82 years (range 80-93). Nivolumab and pembrolizumab were mainly used. In the NSCLC group, median PFS and OS were 2.3 months (95%CI 1.8-6.1) and 8.8 months (95%CI 5.5-18.1), respectively. In the melanoma group, median PFS and OS were 10.2 months (95%CI 4.5-20.0) and 24.5 months (95%CI 14.1-NR), respectively. The albumin level was found to be independently associated with a better OS in both groups. Grade 3-4 toxicities occurred in 15 patients (18.5%). One patient died from ICI-induced pulmonary toxicity. CONCLUSION Our study findings suggest that treatment with ICI in elderly patients with NSCLC and melanoma has a risk-benefit ratio that supports its use. However, we report in this cohort that one in five patients has a grade 3-4 IRAEs leading to treatment discontinuation. Geriatric assessment prior to initiation of therapy and during therapy should be routine in patients aged 80 years and older.
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Affiliation(s)
- Soraya Benguerfi
- CHU Rennes, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France
| | - Thierry Lesimple
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Roch Houot
- Department of Hematology, CHU de Rennes, INSERM U1236, University of Rennes, Rennes, France
| | - Charles Ricordel
- Department of Respiratory Medicine, Pontchaillou Hospital, Rennes 1 University, Rennes, France.,INSERM, OSS (Oncogenesis Stress Signaling), UMR_S 1242, CLCC Eugene Marquis, Université de Rennes 1, Rennes, France
| | - Delphine Legoupil
- Department of Dermatology, Centre Hospitalier Universitaire Brest Morvan, Brest, France
| | - Corinne Alleaume
- Department of Medical Oncology, CH Saint-Brieuc, Saint-Brieuc, France
| | | | - Delphine Deniel Lagadec
- Department of Dermatology, Centre Hospitalier Universitaire Brest Morvan, Brest, France.,Unité de Coordination en Oncogériatrie de Bretagne, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Romain Corre
- Department of Medical Oncology, CH de Cornouaille, Quimper, France
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Howell AV, Gebregziabher M, Thiers BH, Graboyes EM, Paulos CM, Wrangle JM, Hunt KJ, Wallace K. Association of age with survival in older patients with cutaneous melanoma treated with immune checkpoint inhibitors. J Geriatr Oncol 2022; 13:1003-1010. [PMID: 35660090 DOI: 10.1016/j.jgo.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Several types of immune checkpoint inhibitors (ICIs) are approved to treat advanced melanoma, but their effectiveness has not been compared in older patients treated outside of a clinical trial. Moreover, evidence suggests that a patient's response to ICI therapy may vary by age and type of ICI. The purpose of this study was to compare survival by ICI type in older patients with melanoma and to investigate treatment effect modification by age. MATERIALS AND METHODS Using the SEER-Medicare database, we identified patients with cutaneous melanoma (2012-2015) treated with an ICI (CTLA-4, PD-1, or combination CTLA-4 + PD-1 inhibitors). Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for ICI types. We used an interaction term and stratified models to test for treatment effect modification by age. RESULTS Of the 1435 patients included in our analysis, 790 (55.1%) received CTLA-4 inhibitors, 512 (35.7%) received PD-1 inhibitors, and 133 (9.3%) were treated with combination ICIs. Median survival ranged from 13.4 months (95%CI: 10.7-16.3) for CTLA-4 inhibitors to 23.5 months (95%CI: 16.2-30.0) for combination ICIs. In multivariable models, the risk of death was lower with PD-1 inhibitors compared to CTLA-4 inhibitors (HR = 0.78, 95%CI: 0.68-0.89). An age*ICI type interaction term was significant (p < 0.001), and survival gains were greater the older age group (≥80) compared to the younger group (65-79). DISCUSSION In a population-based setting, we identified important differences in survival by ICI type in older patients with melanoma treated with ICIs, with prolonged survival associated with PD-1 inhibitors compared to CTLA-4 inhibitors.
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Affiliation(s)
- Ashley V Howell
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bruce H Thiers
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Chrystal M Paulos
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - John M Wrangle
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly J Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kristin Wallace
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Treatment of Metastatic Melanoma in the Elderly. Curr Oncol Rep 2022; 24:825-833. [PMID: 35316844 DOI: 10.1007/s11912-022-01257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This study aims to review the clinical experience of melanoma treatments in patients with advanced age. RECENT FINDINGS During the last decade, the treatment paradigm for melanoma has changed dramatically with the use of checkpoint inhibitors, oncolytic viruses, and targeted therapies. We reviewed both the clinical trial and real-world experience of these therapies in patients of advanced age, and discuss how a personalized approach should be taken for these patients with consideration of incidence and management of side effects. Although special consideration should be taken, immunotherapy, oncolytic viruses, and targeted therapy have shown efficacy and tolerability in older patients with melanoma.
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma: A population-based study. Medicine (Baltimore) 2021; 100:e24782. [PMID: 33607829 PMCID: PMC7899862 DOI: 10.1097/md.0000000000024782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
Improvement in overall survival by immune checkpoint inhibitors (ICI) treatment in clinical trials encourages their use for late-stage melanoma. However, in the real-world, heterogeneity of population, such as older patients with multimorbidity, may lead to a slower diffusion of ICIs. The objective of this study was to examine the association of multimorbidity and other factors to ICI use among older patients with late-stage melanoma using real world data.A retrospective cohort study design with a 12-month baseline and follow-up period was adopted with data from the linked Surveillance, Epidemiology, and End Results cancer registry/Medicare database. Older patients (>65 years) with late-stage (stage III/IV) melanoma diagnosed between 2012 and 2015 were categorized as with or without multimorbidity (presence of 2 or more chronic conditions) and ICI use was identified in the post-index period. Chi-square tests and logistic regression were used to evaluate factors associated with ICI use.In the study cohort, 85% had multimorbidity, 18% received any treatment (chemotherapy, radiation, and/or ICI), and 6% received ICI. Only 5.5% of older patients with multimorbidity and 6% without multimorbidity received ICIs. Younger age, presence of social support, lower economic status, residence in northeastern regions, and recent year of diagnosis were significantly associated with ICI use; however, multimorbidity, sex, and race were not associated with ICI use.In the real-world clinical practice, only 1 in 18 older adults with late stage melanoma received ICI, suggesting slow pace of diffusion of innovation. However, multimorbidity was not a barrier to ICI use.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research and Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Kimberly M. Kelly
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Virginia G. Scott
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Usha Sambamoorthi
- Professor and Associate Dean of Health Outcomes Research, Department of Pharmacotherapy University of North Texas Health Sciences Center College of Pharmacy
- Vashisht Professor, Health Disparities, Health Education, Awareness & Research in Disparities Scholar, Texas Center for Health Disparities, HSC, Fort Worth TX
- Professor Emeritus, West Virginia University School of Pharmacy, Pharmaceutical Systems and Policy, Morgantown WV
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Correia de Sá T, Ferreira AI, Barreto F, Santos M. Jejunal intussusceptions due to metastatic malignant melanoma: a case report. J Surg Case Rep 2021; 2021:rjaa553. [PMID: 33505653 PMCID: PMC7816794 DOI: 10.1093/jscr/rjaa553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022] Open
Abstract
Intussusception is an infrequent cause of mechanical bowel obstruction in adults and surgical resection is warranted in most cases. Small bowel is a common site of recurrence from cutaneous melanoma but early diagnosis is still a challenge. Acute peritonitis, haemorrhage and obstruction are known clinical presentations. Wide surgical excision with free margins and accompanied mesentery is the treatment of choice and may improve the prognosis. We present a case of small bowel obstruction due to three intussusceptions by metastatic malignant melanoma submitted to surgery.
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Affiliation(s)
- Tiago Correia de Sá
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, 4564-007, Guilhufe, Portugal
| | - Ana Isabel Ferreira
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, 4564-007, Guilhufe, Portugal
| | - Filomena Barreto
- Anatomic Pathology Department, LAP/UNILABS, 4250-170, Porto, Portugal
| | - Mariana Santos
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, 4564-007, Guilhufe, Portugal
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10
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Babbush KM, Damanpour S. Melanoma Diagnosis and Treatment in the Elderly. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Immune checkpoint inhibitors retain effectiveness in older patients with cutaneous metastatic melanoma. J Geriatr Oncol 2020; 12:394-401. [PMID: 33132048 DOI: 10.1016/j.jgo.2020.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have dramatically changed the treatment landscape for advanced melanoma, but their use in older patients remains understudied. An age-related decline in immune function is of concern when treating older patients because host immune factors can influence clinical outcomes with immunotherapy. Therefore, we aimed to evaluate the effectiveness of ICIs in patients 65 years and older. METHODS Using the SEER-Medicare data, we evaluated survival by first systemic treatment type in a retrospective cohort study of patients aged 65 years and older who were diagnosed with stage IV cutaneous melanoma between 2012 and 2015. Cox proportional hazards regression was used to estimate hazard ratios (HR) and their corresponding 95% confidence intervals. RESULTS A total of 541 patients were included in this study. Median survival differed significantly between groups (p < 0.0001) and was longest in patients treated with PD-1 inhibitors (34.0 months), followed by CTLA-4 inhibitors (16.8 months), targeted therapy (9.7 months), chemotherapy (7.1 months), and no systemic therapy (3.6 months). The ICI survival benefit persisted after adjusting for age, sex, comorbidities, M stage, the presence of brain metastases, and evaluation at an NCI-designated cancer center. Hazard ratios comparing ICIs to no systemic therapy were 0.35 (95% CI: 0.24-0.52) for PD-1 inhibitors and 0.48 (95% CI: 0.37-0.63) for CTLA-4 inhibitors. We did not observe a difference in ICI effectiveness by age group (65-74 vs ≥75). CONCLUSIONS In a nationally representative cohort of patients with advanced melanoma, ICI therapy delivered in a real world setting significantly improved survival in patients aged 65 years and older.
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Iacono D, Vitale MG, Basile D, Pelizzari G, Cinausero M, Poletto E, Pascoletti G, Minisini AM. Immunotherapy for older patients with melanoma: From darkness to light? Pigment Cell Melanoma Res 2020; 34:550-563. [PMID: 32745351 DOI: 10.1111/pcmr.12917] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/10/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023]
Abstract
Approximately 40% of malignant melanomas are diagnosed in patients older than 65 years. Elderly patients with melanoma present clinicopathological features related to a more aggressive biology, and they are often diagnosed with advanced stage of disease. Interestingly, in older patients the immune system can be altered with changes both in the innate system and in the adaptive immune system with the acquisition of a pro-inflammatory and immune suppressive phenotype. Immunotherapy with immune checkpoint inhibitors has reshaped the treatment strategies and prognosis of patients with melanoma, and particularly, older age should not be considered a contraindication for immunotherapy. However, data regarding efficacy and safety of immunotherapy in elderly population are still limited because frail older patients are generally excluded from clinical trials. Recently, real-world data have shed light on similar efficacy and safety of immunotherapy in older population compared with younger counterpart. The aim of the present review was to summarize the available knowledge on the underlying immune system in older patients with a diagnosis of melanoma and the immunotherapeutic approaches in this population.
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Affiliation(s)
- Donatella Iacono
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Maria Grazia Vitale
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Marika Cinausero
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Elena Poletto
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Gaetano Pascoletti
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
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Ridolfi L, De Rosa F, Petracci E, Tanda ET, Marra E, Pigozzo J, Marconcini R, Guida M, Cappellini GCA, Gallizzi G, Occelli M, Pala L, Gambale E, Bersanelli M, Galdo G, Cortellini A, Morgese F, Zoratto F, Stucci LS, Strippoli S, Guidoboni M. Anti-PD1 antibodies in patients aged ≥ 75 years with metastatic melanoma: A retrospective multicentre study. J Geriatr Oncol 2020; 11:515-522. [DOI: 10.1016/j.jgo.2019.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/29/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
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14
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Archibald WJ, Victor AI, Strawderman MS, Maggiore RJ. Immune checkpoint inhibitors in older adults with melanoma or cutaneous malignancies: The Wilmot Cancer Institute experience. J Geriatr Oncol 2020; 11:496-502. [DOI: 10.1016/j.jgo.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023]
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15
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Bastholt L, Schmidt H, Bjerregaard JK, Herrstedt J, Svane IM. Age favoured overall survival in a large population-based Danish patient cohort treated with anti-PD1 immune checkpoint inhibitor for metastatic melanoma. Eur J Cancer 2019; 119:122-131. [DOI: 10.1016/j.ejca.2019.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/04/2019] [Accepted: 06/28/2019] [Indexed: 02/08/2023]
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16
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Iglesias-Pena N, Paradela S, Tejera-Vaquerizo A, Boada A, Fonseca E. Cutaneous Melanoma in the Elderly: Review of a Growing Problem. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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17
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Iglesias-Pena N, Paradela S, Tejera-Vaquerizo A, Boada A, Fonseca E. Cutaneous Melanoma in the Elderly: Review of a Growing Problem. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:434-447. [PMID: 31101317 DOI: 10.1016/j.ad.2018.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/26/2018] [Accepted: 11/04/2018] [Indexed: 12/14/2022] Open
Abstract
Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly.
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Affiliation(s)
- N Iglesias-Pena
- Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - S Paradela
- Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España.
| | - A Boada
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - E Fonseca
- Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
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18
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Al-Mansour Z, Pang L, Bathini V. Novel Cancer Therapeutics in Geriatrics: What is Unique to the Aging Patient? Drugs Aging 2019; 36:1-11. [PMID: 30478744 DOI: 10.1007/s40266-018-0619-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
With the worldwide trend of aging populations, the number of older adults who develop and survive cancer is likely to increase. In the last decade, oncology drug development has shifted away from conventional chemotherapeutics towards agents that can 'target' a driver mutation of a specific cancer or 'unleash' the patient's native immune system to attack the cancer-so-called molecularly targeted therapies and immunotherapeutics. The basic algorithms of cancer treatment in elderly patients are essentially the same as in younger patients; however, one needs to pay exceptional attention to the effects of co-morbidities, interaction with other drugs, and the organ function reserve of an older individual before determining his/her 'eligibility' for a specific cancer treatment modality. Despite the growing evidence of safety and effectiveness of combination chemotherapy in fit elderly patients, the data are still lacking concerning the use of currently approved targeted agents and immunotherapies. The current evidence, though limited, suggests reasonable tolerability with comparable efficacy in patients > 65 years old treated with immune-based therapies to that in younger controls; however, it is unclear if this leads to significant patient-relevant gains such as improved survival with an acceptable quality of life. Nonetheless, these newer agents remain better tolerated than cytotoxic chemotherapy in clinical practice, particularly in older patients. Alternatively, a personalized approach for elderly patients with consideration of the incidence and management of adverse effects, as well as strategies for optimizing efficacy in the context of an aging immune system, would be of utmost value in our aging cancer population. Future trials should also explore immune markers to predict response to these therapeutics in elderly patients, taking into consideration the effects of immunosenescence and immune modulation in aging hosts.
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Affiliation(s)
- Zeina Al-Mansour
- Division of Hematology/Oncology, University of Massachusetts School of Medicine, Office #S5-726, 55 Lake Ave N, Worcester, MA, 01655, USA.
| | - Linda Pang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Venu Bathini
- University of Massachusetts School of Medicine, Worcester, MA, USA
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