IL TRATTAMENTO DEL MELANOMA METASTATICO NEL PAZIENTE ANZIANO M. Narracci, A. Romanini Vol.2 (2017), issue 3, pag.1-13
Accepted for pubblication
Melanoma incidence is constantly rising worldwide. Te burden of the disease falls on elderly patients and the highest disability-adjusted life years rates for metastatic melanoma (MM) concerns mainly patients older than 75 years. The management of this cancer is completely changed from the introduction of immune check point inhibitors, anti CTLA-4 and anti PD1, and targeted agents BRAF and MEK inhibitors.
Despite epidemiological data, MM elderly patients are always under-represented in randomized controlled trials (RCTs). Furthermore, some preclinical evidence suggest that immune senescence mechanisms could impaire acquired immune response resulting in a detrimental efect on the efcacy of immune check point inhibitors. Considering the results reported by meta-analysis of RCTs and some retrospective studies, a detrimental efect of age on outcomes in MM patients treated with immune check point inhibitors it is not confrmed. Ipilimumab could have an inferior OS beneft in MM patients older than 75 compared to youger patients, possibly due to its toxicity profle, while anti PD1
are considered equally efective and safe in elderly patients compared to younger ones. Data do not suggest worse outcomes of combined targeted agents in elderly but a more careful monitoring of adverse events is suggested in patients with cardiovascular or ocular comorbidities treated with MEK inhibitors.
In daily clinical practice, immune check point inhibitors, targeted agents and local therapies should be considered in treatment of elderly MM patients, with careful evaluation of comorbidities. Te accrual of elderly MM patients in RCTs should be encouraged.