OBJECTIVES : Although immune checkpoint inhibitors (ICIs) have been approved since the last decade as the first-line of treatment for late-stage melanoma, real-world evidence on ICI utilization is lacking, specifically among those with multimorbidity. This study examined the treatment patterns of current therapies and uptake of ICI among older patients with late-stage melanoma.

METHODS : This was a retrospective study with a 12-month baseline and follow-up period. Data on older fee-for-service Medicare beneficiaries (age >65 years) diagnosed with late-stage (stage III/IV) melanoma between 2011 and 2015 from SEER-Medicare database were used. Presence of multimorbidity was defined as the co-existence of two or more chronic conditions prior to the diagnosis of late-stage melanoma. The use of ICIs, chemotherapy, and radiation was measured in the follow-up period. Adjusted logistic regressions were used to examine the association of multimorbidity to ICI use.

RESULTS : Among 4,519 older patients (mean age =77.7, SD=7.8 years) with late-stage melanoma, 85% had multimorbidity and 19% received any treatment. Our study shows that there were no differences in type of treatment, including chemotherapy (3% vs 4%), radiation (14 vs 14.1%), and ICI (5.5% vs. 6%), among those with and without multimorbidity. Patients treated with existing therapies (chemotherapy and radiation) were more likely to receive ICIs compared to those who had received no treatment.

CONCLUSIONS : In patients with late-stage melanoma, the treatment rates were low. One in 18 older patients with late-stage melanoma received ICI. Most of these patients had also received other treatments, such as chemotherapy and radiation. These findings taken together suggest that robust evidence from randomized clinical trials has not been “advanced to action”. Furthermore, multimorbidity was not a barrier to cancer care in older patients with late-stage melanoma.