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Eochagain CM, Neuendorff NR, Gente K, Leipe J, Verhaert M, Sam C, de Glas N, Kadambi S, Canin B, Gomes F, Decoster L, Korc-Grodzicki B, Rostoft S, Battisti NML, Wildiers H. Management of immune checkpoint inhibitor-associated toxicities in older adults with cancer: recommendations from the International Society of Geriatric Oncology (SIOG). Lancet Oncol 2025; 26:e90-e102. [PMID: 39914430 DOI: 10.1016/s1470-2045(24)00404-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 05/07/2025]
Abstract
Immune checkpoint inhibitors (ICIs) have substantially advanced the treatment landscape for a wide variety of malignancies. Older adults represent a large and rapidly growing demographic, among whom ICIs are widely prescribed. Management of ICI-associated toxicity among older adults, particularly in the presence of frailty and comorbidity, poses unique challenges. In this Policy Review, developed by the International Society of Geriatric Oncology (SIOG), we offer an evidence-based framework for health-care providers, caregivers, and policy makers for treating older adults with ICIs, focusing on unique considerations for this population that are not adequately addressed by existing guidelines, and expanding them to encompass geriatric oncology principles.
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Affiliation(s)
- Colm Mac Eochagain
- Trinity St James' Cancer Institute, Dublin, Ireland; Mercer Institute for Successful Aging, St James' Hospital, Dublin, Ireland.
| | - Nina Rosa Neuendorff
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Bochum, Germany
| | - Karolina Gente
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Division of Rheumatology, Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Marthe Verhaert
- Laboratory for Medical and Molecular Oncology, Translational Oncology Research Center, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Nienke de Glas
- Department of Medical Oncology, Helse Førde, Førde, Norway; Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Beverly Canin
- Cancer and Aging Research Group, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Fabio Gomes
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - Lore Decoster
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Siri Rostoft
- Department of Geriatric Medicine and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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Stoff R, Markovic SN, McWilliams RR, Kottschade LA, Montane HN, Dimou A, Dudek AZ, Tan W, Dronca RS, Seetharam M, Chen R, Block MS. Real-world evidence on efficacy and toxicity of targeted therapy in older melanoma patients treated in a tertiary-hospital setting. Melanoma Res 2024; 34:510-518. [PMID: 39207855 PMCID: PMC11524625 DOI: 10.1097/cmr.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
Melanoma is the deadliest form of skin cancer. The median age at diagnosis is 66. While most patients are treated with immunotherapy, the use of targeted therapy is a valid alternative for patients whose tumors harbor a BRAF or c-KIT driver mutation. These agents, while effective, come with a variety of side effects which limit their use, especially in older patients. We sought to assess the efficacy and toxicity of these agents in older melanoma patients. Melanoma patients over 65 treated with BRAF/MEK or c-KIT inhibitors were retrospectively identified, and their data were analyzed for treatment efficacy and toxicity. All data were compared using the Chi-square test for categorical comparisons and the Kruskal-Wallis method for median comparisons. One hundred and sixteen patients were identified. One hundred and six patients were treated with BRAF/MEK inhibitors. The assessed response rate (RR) was 83% and was comparable across different subgroups, including advanced line patients and those with a more aggressive disease. The median progression free survival (PFS) was 7.9 months, and the median overall survival (OS) was 15.7 months. Twenty-seven percent experienced grade 3-4 toxicity leading to a 24% treatment discontinuation rate. Another 10 patients were treated with the c-KIT inhibitor imatinib, for whom the assessed RR was 55%. The median PFS was 4.3 months, and the median OS was 22.6 months. Forty percent needed dose reductions, yet none had to stop treatment due to adverse effects. The use of targeted therapy in older patients is effective yet challenging due to toxicity. Deploying mitigation strategies can help maximizing their usefulness.
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Affiliation(s)
- Ronen Stoff
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Svetomir N. Markovic
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Robert R. McWilliams
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Lisa A. Kottschade
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Heather N. Montane
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Anastasios Dimou
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Arkadiusz Z. Dudek
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - Winston Tan
- Department of Hematology and Oncology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida
| | - Roxana S. Dronca
- Department of Hematology and Oncology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida
| | - Mahesh Seetharam
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Scottsdale, Arizona, USA
| | - Ruqin Chen
- Department of Hematology and Oncology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida
| | - Matthew S. Block
- Department of Medical Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
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Aldenhoven L, van Weezelenburg MAS, van den Berkmortel FWPJ, Servaas N, Janssen A, Vissers YLJ, van Haaren ERM, Beets GL, van Bastelaar J. lnsights into Adjuvant Systemic Treatment Selection for Patients with Stage III Melanoma: Data from the Dutch Cancer Registry. Target Oncol 2024; 19:735-745. [PMID: 39182000 PMCID: PMC11393025 DOI: 10.1007/s11523-024-01090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Patient demographics and shared decision making might influence the choice of adjuvant therapy for stage III melanoma. OBJECTIVE To identify factors for treatment selection of patients diagnosed with stage III melanoma to better understand current treatment decisions and improve further treatment counseling. PATIENTS AND METHODS Data from 2007 patients diagnosed with stage III melanoma, between December 2018 and 2021, sourced from the Dutch Cancer Registry, were analyzed. RESULTS Among the cohort, 48.7% received no therapy, 45.8% received checkpoint inhibition, and 5.5% received targeted therapy (TT). Patients foregoing therapy were significantly older [67.0 years (range 53.0-77.0) vs. 62.0 year (range 52.0-72.0)], had poorer performance scores (PS), and higher Charlson Comorbidity Index scores compared to those receiving therapy (p < 0.001). Patients undergoing therapy had significantly higher median Breslow thickness (3.3 mm vs. 2.2 mm) and higher prevalence of ulceration (49.9% vs. 38.1%). Those with connective tissue disease and/or congestive heart disease were more likely to receive TT [odds ration (OR) 8.1; 95% confidence interval (CI) 1.7-37.6 and OR 9.3; 95% CI 1.2-72.2, respectively]. Median treatment time among strata for disease recurrence was 4.26 months (3.69-4.82) for immunotherapy and 3.1 months (0.85-5.36) for TT (p = 0.298). Patients who developed recurrent disease were equal across treatment types (p = 0.656). The number of patients with grade 3 complications was different for each treatment type [immunotherapy: 17.8% vs. TT: 37.3% (p < 0.001)]. CONCLUSIONS Age, PS, and Breslow thickness seem to influence adjuvant treatment decisions. Clinicians' preference for immunotherapy might play a role in counseling BRAF-positive patients for adjuvant therapy, this however, cannot be confirmed in this dataset. Overall, only a small proportion of patients completed adjuvant treatment.
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Affiliation(s)
- Loeki Aldenhoven
- Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands.
| | | | | | - Nick Servaas
- Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Elisabeth R M van Haaren
- Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Center, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
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van der Ziel D, Derks MGM, Kapiteijn E, Bastiaannet E, Louwman M, van den Bos F, Mooijaart SP, Portielje JEA, de Glas NA. Time Trends in Treatment Strategies and Survival of Older versus Younger Patients with Synchronous Metastasised Melanoma-A Population-Based Study in the Netherlands Cancer Registry. Cancers (Basel) 2022; 14:cancers14194904. [PMID: 36230827 PMCID: PMC9563569 DOI: 10.3390/cancers14194904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Around 45% of patients with melanoma are older than 65 years. In recent years, immunotherapy has proven very effective for metastasised melanoma. The aim of this study was to investigate the time trends in treatment strategies and survival in older versus younger patients with synchronous metastasised melanoma. We included all patients diagnosed between 2000 and 2019 from the Netherlands cancer registry. We analysed changes in first-line systemic treatment using multivariable logistic regression models, stratified by age (<65, 65−75, and ≥75). Changes in overall survival were studied using multivariable Cox regression analysis. A total of 2967 patients were included. Immunotherapy prescription increased significantly over time for all age groups (<65 years: 11.8% to 64.9%, p < 0.001; 65−75 years: 0% to 68.6%, p < 0.001; >75 years: 0% to 39.5%, p < 0.001). In multivariable analyses, overall survival improved for patients aged <65 and 65−75 (HR 0.96, 95% CI 0.92−1.00 and HR 0.95, 95% CI 0.89−1.00, respectively), but not in patients over 75 (HR 0.98, 95% CI 0.91−1.05). In conclusion, overall survival has improved in patients with synchronous metastasised melanoma aged <75 years, but not in patients aged 75 years or older. This might be explained by lower prescription rates of immunotherapy in this age group.
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Affiliation(s)
- Daisy van der Ziel
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marloes G. M. Derks
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marieke Louwman
- Department of Research and Development, Netherlands Comprehensive Cancer Center, Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Frederiek van den Bos
- Department of Gerontology & Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology & Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Johanneke E. A. Portielje
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nienke A. de Glas
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-715262325
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