Metastatic Melanoma in the Older Patient

Immunologic Insights and Treatment Outcomes

Upendra P Hegde; Nitya Chakraborty; Bijay Mukherji; Jane M Grant Kels

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2011;11(2):185-193. 

In This Article

Is Older Age an Independent Variable of Poor Prognosis in Older Patients with MM?

With the rapid growth of the aging population, and age being a poor prognostic marker for CM, a large number of older patients will be presenting with MM with clinical conditions unique to their age.[15] Although a number of geriatric population-based studies have recognized progressive impairment of organ systems with advancing age, advances in healthcare have led to a significant improvement in quality of life for older adults, increasing the numbers of fit elderly individuals. Therefore, it is conceivable that a significant number of elderly patients with MM may be in relatively good health and subsequently seek treatment for MM.

Since the outcome of patients with MM is poor and its treatment typically includes biological agents, such as IL-2, IFN-α and/or chemotherapeutic agents that have significant toxicities, it is likely that either older patients opt out of active treatment or are otherwise not encouraged to undergo aggressive treatment that their younger counterparts might receive. In addition, very scant information is available about treatment outcomes for older patients with MM as older patients are under-represented in large clinical trials that test therapeutic modalities. In summary, when planning treatment recommendations for elderly patients with MM, very little data exist to convey risk–benefit ratio and treatment outcomes from the available treatments that non-elderly patients benefit from.

Early animal studies suggested slower tumor growth and longer survival times in C57/BL/6 mice transplanted with B16-F10 melanoma,[16] while others have reported contrasting observations.[17] Kaptzan et al. have reported reduced aggressiveness of B16 melanoma in older mice with favorable effects of anti-angiogenic agents.[18] Brand et al. reported prolonged survival of 2 years or longer in 29 out of 442 patients with disseminated melanoma.[19] Factors affecting longer survival in a multivariate analysis included female gender, site of metastatic cancer, number of metastases and feasibility of surgical resection of metastatic cancer. A combination of surgery and chemotherapy resulted in the longest median survival time of 72 months and old age did not impart a poor prognosis on a multivariate analysis of prognostic factors. Surprisingly, 11 out of the 29 patients reported with disseminated melanoma in this study who survived for 2 years or more were 60 years of age or older. Other studies did not report older age to be a poor prognostic factor when treating patients with MM.[20] Thus, although older age is consistently reported to be a poor prognostic marker in patients with CM, its prognostic impact in older patients with MM is less clear. Since MM is not chemosensitive in general and treatment is largely immune based, it is important to understand the effects of the aging immune system on treatment outcomes of older melanoma patients with MM.

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