Treatment patterns and outcomes by age in metastatic melanoma: A study of the National Cancer Database.

Abstract

12037Background: Metastatic melanoma carries poor prognosis and traditional chemotherapy has limited efficacy. Immune checkpoint inhibitors (ICI) have drastically improved disease outcomes since first approved in 2011. Elderly patients were underrepresented in landmark early trials of ICI leading to limited clinical trial data on efficacy and treatment patterns in this population. We aimed to examine the real-world IO outcomes and demographics of elderly patients in the National Cancer Database. Methods: We queried the database for patients with stage IV melanoma diagnosed between 2011-2015 with survival data available. Patients were divided into receipt of immunotherapy (IO) or no receipt of IO; those without documentation were excluded. Cases were separated into 3 cohorts of age at diagnosis (60 years-old or younger, 61-74 years-old, and 75 years-old and greater). Descriptive variables were compared by Chi-squared analysis and survival analyses were performed by Kaplan-Meier method and log-rank test. Results: 11,265 cases met inclusion criteria: 4,117 aged 60 or less, 3,940 aged 61-74, and 3,208 aged 75 or older. Those receiving immuno-oncologic agents (IO) in all age groups showed a longer median OS (mOS) than those who did not receive IO (mOS overall 17.28 v 7.49; p <0.01). Survival was longer in all age cohorts when IO was received compared to not received; ages less than 60 (mOS 20.3 v 9.2m; p<0.01), ages 61-74 (mOS 15.5 v 7.8m; p<0.01), and ages 75 or greater (mOS 14.4 v 5.8m; p<0.01). A greater percentage of patients received IO in younger than older cohorts, 20.1% in ≥ 75, 37.6% in 61-74, and 42.3% in ≤ 60; p <0.01. Additional descriptive variables shown in the table were compared between the cohorts include care at academic or integrated cancer network, uninsured, Charlson-Deyo Comorbidity Index (CDCI) of 2 or greater, and documented inclusion of palliative care treatment. Conclusions: Substantial survival benefit is realized with IO in all age cohorts although elderly cohorts did not receive IO as often as younger cohort. Elderly patients experienced lower rates of care at academic/network cancer programs, lower uninsured rate, and higher CDCI. [Table: see text]