RISK OF IMMUNE CHECKPOINT INHIBITOR (ICI) DISCONTINUATION IN OLDER ADULTS WITH MELANOMA, A POPULATION-BASED STUDY
Author(s)
Swapnil Sharma, MD, MPH1, Haley Yao, BS2, Krupa Gandhi, MPH3, Amy L. Shaver, MPH, PharmD, PhD1, Scott Keith, PhD4, Rino Seedor, MD5, Richard Hass, PhD6, Nikita Nikita, MD, MPH1;
1Thomas Jefferson University, Department of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Philadelphia, PA, USA, 2Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA, 3Thomas Jefferson University, Department of Pharmacology, Physiology, and Cancer Biology, Philadelphia, PA, USA, 4Thomas Jefferson University, Department of Pharmacology, Physiology and Cancer Biology, Sidney Kimmel Comprehensive Cancer Center, Philadelphia, PA, USA, 5Thomas Jefferson University, Sidney Kimmel Comprehensive Cancer Center, Philadelphia, PA, USA, 6Thomas Jefferson University, Jefferson College of Population Health, Philadelphia, PA, USA
1Thomas Jefferson University, Department of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Philadelphia, PA, USA, 2Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA, 3Thomas Jefferson University, Department of Pharmacology, Physiology, and Cancer Biology, Philadelphia, PA, USA, 4Thomas Jefferson University, Department of Pharmacology, Physiology and Cancer Biology, Sidney Kimmel Comprehensive Cancer Center, Philadelphia, PA, USA, 5Thomas Jefferson University, Sidney Kimmel Comprehensive Cancer Center, Philadelphia, PA, USA, 6Thomas Jefferson University, Jefferson College of Population Health, Philadelphia, PA, USA
OBJECTIVES: Immune checkpoint inhibitors (ICIs) have become a standard treatment for melanoma, significantly improving patient outcomes. However, the data on risk factors associated with ICI discontinuation in older adults is limited, as these patients are often excluded from ICI clinical trials. This study aims to assess the risk factors for ICI discontinuation among older adults with melanoma.
METHODS: We used SEER-Medicare data to identify patients aged ≥66 with melanoma (1999-2017) and treated with ICIs (2011-2019). ICI discontinuation was defined as a ≥ 120-day gap between claims for initial ICI and/or initiation of new cancer therapy. ICIs were identified using the Healthcare Common Procedure Coding System (HCPCS) codes. Fine and Gray’s competing risk hazard model was used to compare the risk of ICI discontinuation by ICI type and the year of ICI initiation.
RESULTS: We identified 3,220 patients, of which 2295 (71.3%) were male, 2,065 (64%) were older than 75 years, and 3,155 (98%) were white. Results showed that the patients on combination ICI therapy were 8.9 times more likely to discontinue ICI than patients on ICI monotherapy (Hazard Ratio (HR): 8.86, 95% Confidence Interval (CI): 7.12-11.02). Risk of ICI discontinuation was lower in the patients who initiated ICI in the later years; 46% lower for those who initiated ICI therapy in 2015-16 (HR: 0.54, 95% CI: 0.44-0.67) and 74% lower for those who initiated ICI therapy in 2017-19 (HR: 0.26, 95% CI: 0.21-0.34), when compared to those who started ICI therapy in 2011-14. Age and CCI score were not significantly associated with the risk of ICI discontinuation.
CONCLUSIONS: Older adults receiving combination therapy had higher discontinuation rates and discontinued treatment earlier. Risk of ICI discontinuation was significantly lower in older adults initiating therapy in later years (2015-2019), suggesting improved treatment delivery and management of adverse events.
METHODS: We used SEER-Medicare data to identify patients aged ≥66 with melanoma (1999-2017) and treated with ICIs (2011-2019). ICI discontinuation was defined as a ≥ 120-day gap between claims for initial ICI and/or initiation of new cancer therapy. ICIs were identified using the Healthcare Common Procedure Coding System (HCPCS) codes. Fine and Gray’s competing risk hazard model was used to compare the risk of ICI discontinuation by ICI type and the year of ICI initiation.
RESULTS: We identified 3,220 patients, of which 2295 (71.3%) were male, 2,065 (64%) were older than 75 years, and 3,155 (98%) were white. Results showed that the patients on combination ICI therapy were 8.9 times more likely to discontinue ICI than patients on ICI monotherapy (Hazard Ratio (HR): 8.86, 95% Confidence Interval (CI): 7.12-11.02). Risk of ICI discontinuation was lower in the patients who initiated ICI in the later years; 46% lower for those who initiated ICI therapy in 2015-16 (HR: 0.54, 95% CI: 0.44-0.67) and 74% lower for those who initiated ICI therapy in 2017-19 (HR: 0.26, 95% CI: 0.21-0.34), when compared to those who started ICI therapy in 2011-14. Age and CCI score were not significantly associated with the risk of ICI discontinuation.
CONCLUSIONS: Older adults receiving combination therapy had higher discontinuation rates and discontinued treatment earlier. Risk of ICI discontinuation was significantly lower in older adults initiating therapy in later years (2015-2019), suggesting improved treatment delivery and management of adverse events.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO149
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Geriatrics, SDC: Oncology