1119P Targeted treatment and immunotherapy in older patients with advanced melanoma: A single institution real-life experience

Abstract

Malignant Melanoma (MM) is associated with poor prognosis in advanced stages and a rising incidence with age. We aim to provide real-life data on targeted therapy (TT) and anti-PD1 safety profile in older MM patients (pts). Retrospective cohort of all consecutive pts ≥ 65 years old (yo) with advanced MM (excluding uveal and mucosal) who started TT or anti-PD1 between Apr’14 and Dec’19 in a Portuguese cancer centre. Data were collected from retrospective chart review: baseline characteristics, primary outcome – safety profile (adverse events [AE], grading by CTCAEv5, and dose reduction or discontinuation due to toxicity). Descriptive analysis performed using frequencies for categorical variables and median and range for continuous variables. We identified 120 pts, 53% male, median age 76.4 yo (range, 65.3-93.3), 80% with ECOG PS 0-1, 91% cutaneous origin, 50% with LDH > ULN, and 18% had brain metastases at baseline. We treated 53 pts (15 pts ≥ 80 yo) with TT: 9 with vemurafenib (V) - 7 1stline; 12 with vemurafenib/cobimetinib (V+C) and 32 with dabrafenib/trametinib (D+T), all 1stline. Seventy-two pts (23 pts ≥ 80yo) received anti-PD1 (pembrolizumab, nivolumab): 64 1stline, 6 2ndline (5 pts after TT, 1 pt after dacarbazine) and 2 3rdline (after dacarbazine and ipilimumab). Ninety-two percent was BRAF wildtype. Most frequent AE (any grade) with TT: rash (89%), photosensitivity (67%) and arthralgia (67%) with V; increased creatinine (58%), increased aminotransferases (50%) and nausea (50%) with V+C; fever (53%), nausea (34%) and fatigue (28%) with D+T. Grade 3-4 in 41% of all pts and 60% of pts ≥ 80 yo. Dose reduction in 53% and discontinuation in 17% of all pts. Most frequent AE (any grade) with anti-PD1: fatigue (46%), pruritus (18%), and hypothyroidism (17%). Grade 3-4 in 15% of all pts and 17% of pts ≥ 80 yo. Discontinuation in 15% of all pts. No toxic deaths were found. Our findings do not show increased incidence of AE in the elderly in a real-life setting as compared topivotal clinical trials. Despite the possibility of under-reporting of AE due to the study design, these findings suggest that age itself should not limit the use of these drugs. Predictive tools of toxicity in this population are needed.