Supplementary Material for: Pembrolizumab for Unresectable or Metastatic Melanoma in Patients Older than 85 Years of Age

<b><i>Background:</i></b> Programmed cell death protein-1 (PD-1) inhibitors (pembrolizumab and nivolumab) have been approved for the treatment of advanced melanoma. Over the past decades, patients older than 85 years represent an expanding group of patients in developed countries. In France, 25% of melanomas are diagnosed in patients older than 75 years. <b><i>Objective:</i></b> To perform a monocentric retrospective study of patients older than 85 years and treated with pembrolizu­mab for unresectable or metastatic melanoma in order to evaluate tolerance and potential benefits of this immunotherapy. <b><i>Methods:</i></b> Medical records of patients treated with the PD-1 inhibitor pembrolizumab between January 2015 and January 2018 were reviewed. <b><i>Results:</i></b> Nine patients (6 women and 3 men) older than 85 years were included in the study. The mean age was 89.6 (85–97) years at inclusion. All patients were PS 0 or 1. The mean number of infusions was 4 (1–12). However, most patients were not able to tolerate the 4-infusion schedule. One patient refused the second infusion for personal reasons. Seven patients had grade 3 or 4 treatment-related adverse events. <b><i>Conclusion:</i></b> These results indicate that pembrolizumab treatment in patients older than 85 years may induce responses but is associated with a high risk of toxicity and impaired autonomy.

【背景】程序性死亡蛋白1（PD-1）抑制剂（帕博利珠单抗（pembrolizumab）与纳武利尤单抗（nivolumab））已获批用于晚期黑色素瘤的治疗。近数十年来，85岁以上患者在发达国家中占比持续扩大。在法国，25%的黑色素瘤确诊患者年龄超过75岁。
【目的】本研究为单中心回顾性研究，旨在评估帕博利珠单抗用于不可切除或转移性黑色素瘤治疗时的耐受性及潜在获益，研究对象为85岁以上患者。
【方法】回顾分析2015年1月至2018年1月期间接受PD-1抑制剂帕博利珠单抗治疗的患者病历资料。
【结果】本研究共纳入9名85岁以上患者，其中女性6名、男性3名。入组时患者平均年龄为89.6岁（范围85~97岁），所有患者的体力状态评分（PS）均为0或1级。平均输注疗程数为4次（范围1~12次），但多数患者无法耐受4次输注的方案。1名患者因个人原因拒绝第二次输注，7名患者出现3级及以上治疗相关不良事件。
【结论】本研究结果显示，帕博利珠单抗用于85岁以上黑色素瘤患者治疗时可产生抗肿瘤应答，但伴随较高的毒性风险及自主功能受损风险。