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Wong SK, Blum SM, Sun X, Da Silva IP, Zubiri L, Ye F, Bai K, Zhang K, Ugurel S, Zimmer L, Livingstone E, Schadendorf D, Serra-Bellver P, Muñoz-Couselo E, Ortiz C, Lostes J, Huertas RM, Arance A, Pickering L, Long GV, Carlino MS, Buchbinder EI, Vázquez-Cortés L, Jara-Casas D, Márquez-Rodas I, González-Espinoza IR, Balko JM, Menzies AM, Sullivan RJ, Johnson DB. Efficacy and safety of immune checkpoint inhibitors in young adults with metastatic melanoma. Eur J Cancer 2023; 181:188-197. [PMID: 36680880 DOI: 10.1016/j.ejca.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The integration of immune checkpoint inhibitors (ICI) for the treatment of melanoma has resulted in remarkable and durable responses. Given the potential role of immunosenescence, age may contribute to differential ICI efficacy and toxicity. While older patients have been studied in detail, outcomes from ICI in young patients (≤40 years) are not well characterised. METHODS We performed a multi-institutional, retrospective study of patients with advanced melanoma treated with anti-PD-1 monotherapy or ICI combination (ipilimumab and anti-PD-1). Response rates, survival, and toxicities were examined based on age comparing those under 40 years of age with older patients (age 41-70 and ≥ 71 years). RESULTS A total of 676 patients were included: 190 patients (28%) aged ≤40 years, 313 (46%) between ages 41-70, and 173 patients (26%) aged ≥71. Patients ≤40 years had higher response rates (53% vs 38%, p = 0.035) and improved progression-free survival (median 13.7 vs 4.0 months, p = 0.032) with combination ICI compared to monotherapy. Progression-free survival was similar among groups while overall survival was inferior in patients >70 years, who had low response rates to combination therapy (28%). ICIs had a similar incidence of severe toxicities, though hepatotoxicity was particularly common in younger patients vs. patients >40 with monotherapy (9% vs. 2%, p = 0.007) or combination ICI (37% vs. 10%, p < 0.001). CONCLUSIONS ICIs had comparable efficacy between younger and older patients, although outcomes were superior with combination ICI compared to monotherapy in patients aged ≤40 years. Toxicity incidence was similar across age groups, though organs affected were substantially different.
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Affiliation(s)
- Selina K Wong
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven M Blum
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xiaopeng Sun
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Inês P Da Silva
- University of Sydney, Melanoma Institute Australia, Sydney, Australia
| | - Leyre Zubiri
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kun Bai
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Selma Ugurel
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lisa Zimmer
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Dirk Schadendorf
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Eva Muñoz-Couselo
- University Hospital Vall D'Hebron, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Carolina Ortiz
- University Hospital Vall D'Hebron, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Julia Lostes
- University Hospital Vall D'Hebron, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Ana Arance
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lisa Pickering
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Georgina V Long
- University of Sydney, Melanoma Institute Australia, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Matteo S Carlino
- University of Sydney, Melanoma Institute Australia, Sydney, Australia; Westmead and Blacktown Hospitals, Melanoma Institute Australia, Sydney, Australia
| | | | | | | | | | | | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander M Menzies
- University of Sydney, Melanoma Institute Australia, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Ryan J Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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