Clinical heterogeneity of elderly melanoma patients in the real-world setting: Potential implications for treatment outcomes following immune based therapy.

Abstract

e21026 Background: Recent studies have indicated that immune checkpoint inhibitor treatment of metastatic melanoma is effective irrespective of older age. However, in the real world setting, not all older patients (pts.) diagnosed with high-risk cutaneous melanoma have same levels of immune function due to wide variation of older age and aging associated diseases that adversely influence it. Frailty associated with co-morbidities, autoimmunity, cancer, and their treatments are three such conditions that influence treatment outcomes following immune based treatment of melanoma in older subjects. To better understand this interaction between melanoma, aging-associated diseases and potential outcomes following immune checkpoint inhibitor treatment in the real world, we reviewed clinical data of elderly melanoma pts. from the University of Connecticut's Neag Cancer Center following an IRB approval. Methods: We retrospectively reviewed clinical characteristics of elderly pts. diagnosed with high-risk cutaneous melanoma (Stage IIC, III, IV) at the University of Connecticut from 2012-2019. Pts. over the age of 60 years were divided into two main groups: Group I ("Fit elderly") and Group II ("Elderly with immune suppressive conditions"). Group II pts. were further divided into three subgroups: A ("Co-morbidities and frailty"), B ("Autoimmunity and its treatment") and C ("Cancer and its treatment"). Results: From 2012-2019, a total of 56 elderly pts. diagnosed with high-risk cutaneous melanoma were stratified as the following: Group I - 31 pts. (55%) and Group II - 25 pts. (45%); among the Group II pts., Group A contained 14 pts. (56%), Group B 5 pts. (20%), and Group C 6 pts. (24%). The median age for all 56 elderly pts. was 77 yrs. (range 61 to 99). In Group I, the median age was 73 yrs. (range 61-91). In Group II, the median age was 82 years (range 66-99); A median age 85 yrs (range 66-99), B median age 78 yrs (range 66-86), and C 80.5 yrs. (range 66-86). 9 out of 56 pts. (16%) did not receive immune checkpoint inhibitor treatment, of which 7 pts. (56%) were frail and 2 pts. (22%) were non-frail. Conclusions: Our data indicate that the existence of significant clinical heterogeneity among high-risk elderly melanoma pts. encountered in the community setting reflects a wide spectrum of immune function. Larger studies stratifying elderly subjects by co-morbidities and immune suppressive conditions will help shed accurate light on clinical relevance of immune based treatment of melanoma in older subjects.