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Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma

SIMPLE SUMMARY: A majority of melanoma occurs in people over 65 years. BRAF and MEK inhibitors are standard of care for BRAF mutated metastatic melanoma. The aim of the study was to explore tolerability of targeted therapy in a cohort of patients extracted from a biobank. Patients treated by BRAF an...

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Autores principales: Becquart, Ondine, Oriano, Bastien, Dalle, Stéphane, Mortier, Laurent, Leccia, Marie Thérèse, Dutriaux, Caroline, Dalac, Sophie, Montaudié, Henri, De Quatrebarbes, Julie, Brunet-Possenti, Florence, Saiag, Philippe, Lesimple, Thierry, Beylot-Barry, Marie, Aubin, Francois, Stoebner, Pierre-Emmanuel, Arnault, Jean-Philippe, Dreno, Brigitte, Porcher, Raphael, Lebbe, Celeste, Guillot, Bernard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235702/
https://www.ncbi.nlm.nih.gov/pubmed/34207200
http://dx.doi.org/10.3390/cancers13123042
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author Becquart, Ondine
Oriano, Bastien
Dalle, Stéphane
Mortier, Laurent
Leccia, Marie Thérèse
Dutriaux, Caroline
Dalac, Sophie
Montaudié, Henri
De Quatrebarbes, Julie
Brunet-Possenti, Florence
Saiag, Philippe
Lesimple, Thierry
Beylot-Barry, Marie
Aubin, Francois
Stoebner, Pierre-Emmanuel
Arnault, Jean-Philippe
Dreno, Brigitte
Porcher, Raphael
Lebbe, Celeste
Guillot, Bernard
author_facet Becquart, Ondine
Oriano, Bastien
Dalle, Stéphane
Mortier, Laurent
Leccia, Marie Thérèse
Dutriaux, Caroline
Dalac, Sophie
Montaudié, Henri
De Quatrebarbes, Julie
Brunet-Possenti, Florence
Saiag, Philippe
Lesimple, Thierry
Beylot-Barry, Marie
Aubin, Francois
Stoebner, Pierre-Emmanuel
Arnault, Jean-Philippe
Dreno, Brigitte
Porcher, Raphael
Lebbe, Celeste
Guillot, Bernard
author_sort Becquart, Ondine
collection PubMed
description SIMPLE SUMMARY: A majority of melanoma occurs in people over 65 years. BRAF and MEK inhibitors are standard of care for BRAF mutated metastatic melanoma. The aim of the study was to explore tolerability of targeted therapy in a cohort of patients extracted from a biobank. Patients treated by BRAF and/or MEK inhibitors were included in two groups (<65 or >65 years) and analyzed for tolerance and efficacy. The cohort included 353 patients: 231 < 65 years and 122 > 65. A total of 80% had at least one adverse effect mainly skin, general, and gastrointestinal disorders. No statistical difference was observed for severe adverse events, adverse events grades, dose modifications, and interruptions in the two groups. Median overall survival was 20.3 and 16.3 months, respectively. This study shows that tolerance of targeted therapy is as good in older patients as in younger with a similar efficacy. There is no argument against using these treatments in elderly people. ABSTRACT: Purpose: Melanoma’s incidence is increasing, and elderly people could be significantly impacted since the majority occurs in people over 65 years of age. Combined BRAF and MEK targeted therapies (TT) are current standard regimen for BRAF mutated metastatic melanoma (MM). Except for subgroups of pivotal trials, little data are available for TT in this population. Materials and Methods: Outcomes were explored in real life patients from MelBase, a French multicentric biobank dedicated to the prospective follow-up of unresectable stage III or IV melanoma. Patients treated by BRAF TT and/or MEK TT combined or not, were included from 2013 to 2017 in 2 groups: group 1 ≤ 65-year-old (yo), group 2 > 65 yo, analyzed for tolerance and efficacy. Results: 353 patients were included: 231 in group 1, 122 in group 2. Median follow-up was 12 months (M). Median time of treatment was 6.9 M. A total of 80% had at least one Adverse Effect (AE). Most frequent AE (all grades) were mainly skin and subcutaneous, general, and gastrointestinal disorders. A total of 31% of AE were grade 3–4: 28% in group 1 and 39% in group 2 (p = 0.05). No differences were observed in all AE grades proportion, dose modifications, interruptions, and discontinuations. For each group, median overall survival was 20.3 M (CI 95%: 15.5–27.9) and 16.3 M (CI: 14.5–26.9), respectively (p = 0.8). Median progression free survival was 7.8 M (6.4–9.9) and 7.7 M (CI: 5.8–11.3) (p = 0.4). Objective response rate was 59% and 50% (p = 0.6). Conclusion: This study on a large multicentric cohort is the first to assess that TT is well tolerated in elderly BRAF-mutated patients such as in patients younger than 65. Efficacy was similar between groups with outcomes reaching those from pivotal studies. There is thus no argument against using TT in elderly people, although an onco-geriatric opinion is welcome for the most vulnerable.
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spelling pubmed-82357022021-06-27 Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma Becquart, Ondine Oriano, Bastien Dalle, Stéphane Mortier, Laurent Leccia, Marie Thérèse Dutriaux, Caroline Dalac, Sophie Montaudié, Henri De Quatrebarbes, Julie Brunet-Possenti, Florence Saiag, Philippe Lesimple, Thierry Beylot-Barry, Marie Aubin, Francois Stoebner, Pierre-Emmanuel Arnault, Jean-Philippe Dreno, Brigitte Porcher, Raphael Lebbe, Celeste Guillot, Bernard Cancers (Basel) Article SIMPLE SUMMARY: A majority of melanoma occurs in people over 65 years. BRAF and MEK inhibitors are standard of care for BRAF mutated metastatic melanoma. The aim of the study was to explore tolerability of targeted therapy in a cohort of patients extracted from a biobank. Patients treated by BRAF and/or MEK inhibitors were included in two groups (<65 or >65 years) and analyzed for tolerance and efficacy. The cohort included 353 patients: 231 < 65 years and 122 > 65. A total of 80% had at least one adverse effect mainly skin, general, and gastrointestinal disorders. No statistical difference was observed for severe adverse events, adverse events grades, dose modifications, and interruptions in the two groups. Median overall survival was 20.3 and 16.3 months, respectively. This study shows that tolerance of targeted therapy is as good in older patients as in younger with a similar efficacy. There is no argument against using these treatments in elderly people. ABSTRACT: Purpose: Melanoma’s incidence is increasing, and elderly people could be significantly impacted since the majority occurs in people over 65 years of age. Combined BRAF and MEK targeted therapies (TT) are current standard regimen for BRAF mutated metastatic melanoma (MM). Except for subgroups of pivotal trials, little data are available for TT in this population. Materials and Methods: Outcomes were explored in real life patients from MelBase, a French multicentric biobank dedicated to the prospective follow-up of unresectable stage III or IV melanoma. Patients treated by BRAF TT and/or MEK TT combined or not, were included from 2013 to 2017 in 2 groups: group 1 ≤ 65-year-old (yo), group 2 > 65 yo, analyzed for tolerance and efficacy. Results: 353 patients were included: 231 in group 1, 122 in group 2. Median follow-up was 12 months (M). Median time of treatment was 6.9 M. A total of 80% had at least one Adverse Effect (AE). Most frequent AE (all grades) were mainly skin and subcutaneous, general, and gastrointestinal disorders. A total of 31% of AE were grade 3–4: 28% in group 1 and 39% in group 2 (p = 0.05). No differences were observed in all AE grades proportion, dose modifications, interruptions, and discontinuations. For each group, median overall survival was 20.3 M (CI 95%: 15.5–27.9) and 16.3 M (CI: 14.5–26.9), respectively (p = 0.8). Median progression free survival was 7.8 M (6.4–9.9) and 7.7 M (CI: 5.8–11.3) (p = 0.4). Objective response rate was 59% and 50% (p = 0.6). Conclusion: This study on a large multicentric cohort is the first to assess that TT is well tolerated in elderly BRAF-mutated patients such as in patients younger than 65. Efficacy was similar between groups with outcomes reaching those from pivotal studies. There is thus no argument against using TT in elderly people, although an onco-geriatric opinion is welcome for the most vulnerable. MDPI 2021-06-18 /pmc/articles/PMC8235702/ /pubmed/34207200 http://dx.doi.org/10.3390/cancers13123042 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Becquart, Ondine
Oriano, Bastien
Dalle, Stéphane
Mortier, Laurent
Leccia, Marie Thérèse
Dutriaux, Caroline
Dalac, Sophie
Montaudié, Henri
De Quatrebarbes, Julie
Brunet-Possenti, Florence
Saiag, Philippe
Lesimple, Thierry
Beylot-Barry, Marie
Aubin, Francois
Stoebner, Pierre-Emmanuel
Arnault, Jean-Philippe
Dreno, Brigitte
Porcher, Raphael
Lebbe, Celeste
Guillot, Bernard
Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma
title Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma
title_full Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma
title_fullStr Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma
title_full_unstemmed Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma
title_short Tolerance and Effectiveness of Targeted Therapies in Aged Patients with Metastatic Melanoma
title_sort tolerance and effectiveness of targeted therapies in aged patients with metastatic melanoma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235702/
https://www.ncbi.nlm.nih.gov/pubmed/34207200
http://dx.doi.org/10.3390/cancers13123042
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