Background: Dual agent immunotherapy (IT) is widely utilised in the treatment of melanoma, and is more effective than single agent therapy. This comes at the expense of increased adverse events (AEs)1. Elderly patients, commonly defined as those older than 65 years, are thought to suffer higher rates of toxicity and have poorer outcomes compared to younger patients with chemotherapy2.
Aim: To assess whether there are higher rates of AEs and poorer clinical outcomes in older patients (>65 years) treated with combination IT compared to younger patients (<65 years).
Methods: A retrospective case control study of patients with melanoma receiving dual agent IT at two Victorian cancer centres. Toxicity rates, grade, admission for toxicity and duration of inpatient stay was recorded and compared between the two age groups.
Results: 72 patients met inclusion criteria; 48 (66%) patients were £ 65 years and 24 (34%) were > 65 years (age range 26-80). In both age groups, 66% of patients were male. Younger patients received a mean of 10.5 cycles of IT compared to 13.5 cycles in the elderly (range 1-50 in young patients, 1-78 in elderly). Younger patients suffered a higher rate of grade 3-5 AEs: 33 (69%) vs 10 (42%) and were more likely to need admission due to an AE: 23 (48%) vs 8 (33%). However, admission duration was longer in the elderly, 8.9 days vs 13.1 days. 4 patients (8%) aged £ 65 died secondary to toxicity; there were no toxicity associated deaths in the elderly.
Conclusion: Elderly patients treated with dual agent IT had a lower rate of Grade 3-5 AEs compared to younger patients. This study demonstrates that dual agent IT is a viable treatment option in appropriate elderly patients with melanoma, and age should not be a limiting factor when considering suitable treatment.