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Novel Therapies for Metastatic Melanoma: An Update on Their Use in Older Patients

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Abstract

Cutaneous melanoma is the most aggressive form of skin cancer. With age as a risk factor, melanoma is projected to become a substantial healthcare burden. The clinical course of melanoma in older patients is different from that in middle-aged and younger patients: melanomas are thicker, have higher mitotic rates and are more likely to be ulcerated. Older patients also have a higher mortality rate, yet, paradoxically, have a lower rate of lymph node metastases. After decades of no significant progress in the treatment of this devastating disease, novel insights into the mechanisms underlying the pathophysiology of metastatic melanoma have led to new and remarkably efficient therapeutic opportunities. The discovery that about half of all melanomas carry BRAF mutations led to the introduction of targeted therapy with significant improvements in clinical outcomes. Although these drugs appear to be equally effective in older patients, specific considerations regarding adverse events are required. Besides targeted therapy, immunotherapy has emerged as an alternative therapeutic option. Antibodies that block cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) can induce responses with high durability. Despite an aging immune system, older patients seem to benefit to the same degree from these treatments, apparently without increased toxicity. In this review, we focus on the epidemiology, clinicopathological features, and recent developments of systemic treatment in cutaneous melanoma with regard to older patients.

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Authors and Affiliations

  1. Department of General Medical Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Aljosja Rogiers, Cindy Kenis, Hans Wildiers & Pascal Wolter

  2. Laboratory for Molecular Cancer Biology, Center for the Biology of Disease, VIB, Leuven, Belgium

    Aljosja Rogiers & Jean-Christophe Marine

  3. Center for Human Genetics, KU Leuven, Leuven, Belgium

    Aljosja Rogiers & Jean-Christophe Marine

  4. Department of Pathology, University Hospitals Leuven, Leuven, Belgium

    Joost J. van den Oord

  5. Department of Dermatology, University Hospitals Leuven, Leuven, Belgium

    Marjan Garmyn

  6. Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium

    Marguerite Stas

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  1. Aljosja Rogiers
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Correspondence to Pascal Wolter.

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Conflict of interest

AR received travel support from BMS. PW has received research support from Pfizer, GSK, and Novartis, and has attended advisory boards from BMS, MSD, Roche, GSK, and Novartis without personal remuneration. All other authors (JJvdO, MG, MS, CK, HW, J-CM) have no conflicts of interest to declare.

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Rogiers, A., van den Oord, J.J., Garmyn, M. et al. Novel Therapies for Metastatic Melanoma: An Update on Their Use in Older Patients. Drugs Aging 32, 821–834 (2015). https://doi.org/10.1007/s40266-015-0304-7

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