Treatment patterns in geriatric patients with melanoma and the effect of age on the efficacy of immunotherapy: Analysis from the real-world multicenter registry ADOREG

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PURPOSE: Data on treatment approaches in geriatric melanoma patients are scant. Efficacy of oncologic treatments across age groups, with special focus on immunotherapy, and the impact of comorbidities were analyzed. METHODS: -test, survival outcomes were compared via log-rank tests. RESULTS: Of 14,356 melanoma patients, 8213 met the inclusion criteria, 6063 and 2150 were < 75 and ≥ 75 years old, respectively. Among the 3646 patients with metastatic disease, older patients received fewer treatment lines and were less likely to undergo surgery, radiotherapy and systemic therapy. However, efficacy of any first-line treatment did not differ between both age groups (p = 0.306). Immunotherapy selection at any line was similar in both groups (p = 0.109), but geriatrics were treated mainly with first-line anti-PD1 monotherapy, whereas combination ICIs was preferred in younger patients. Efficacy was not impaired (PFS and MSS: p > 0.05), while toxicity rates were lower. This pattern persisted across CCI categories. CONCLUSION: Age influenced treatment selection in melanoma patients. However, in geriatric patients, efficacy was not impaired, and a balanced toxicity profile was noticed, particularly for immunotherapy. Future studies considering biological age and impairment by comorbidities seems important to assess individualized treatment approaches.

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