Cancer Immunology, Immunotherapy

, Volume 68, Issue 4, pp 545–551 | Cite as

Adverse events need for hospitalization and systemic immunosuppression in very elderly patients (over 80 years) treated with ipilimumab for metastatic melanoma

  • Vaianu Leroy
  • Emilie Gerard
  • Caroline Dutriaux
  • Sorilla Prey
  • Aurelia Gey
  • Cécile Mertens
  • Marie Beylot-Barry
  • Anne Pham-LedardEmail author
Original Article



Checkpoint inhibitors are first-line therapies in melanoma, but safety in older adults has not yet been assessed. Ipilimumab improves survival, but immunologic-related adverse events (AEs) can be threatening, and its use in elderly people raises questions.


To assess safety in a cohort of very elderly patients treated with ipilimumab.


All patients over 80 years treated with ipilimumab for melanoma were retrospectively included. AE occurrence, management, and outcome, as well as response rate at week 16 and overall survival were recorded, and compared to data for a group of younger patients treated in our institution during the same period.


In the elderly group, 23 patients were included with a median age of 82 years [80–90]. AEs amounting to 23 occurred in 15 patients (65%) with 5 grade 3 (22%) and 1 grade 5 (opportunistic infection) AEs. Corticosteroids were required for five (22%) patients, additive immunosuppressive therapy for two, hospitalization for four, and definitive interruption of ipilimumab for three. Median overall survival was 14 months. In the younger group, 29 patients were included with a median age of 58 years. AEs occurred in 15/29 (52%) with 4 grade 3 (19%) and 1 grade 4 (7%). Median OS was 17 months.


Serious AEs occurred in 80 + adults at the same rate as observed in our younger patients and as previously reported in younger populations. Ipilimumab can be an option in elderly patients, as patients may benefit from therapy and safety seems to be manageable.


Ipilimumab Checkpoint inhibitors Elderly Older adults Adverse events Melanoma 



Adverse events


Anti-tumor-necrosis-factor alpha inhibitors


B-Raf proto-oncogene


Confidence interval

CT scan

Computed tomography scan

ECOG status

Eastern Cooperative Oncology Group status


Hazard ratio


Immunologic-related adverse events


Lactate dehydrogenase


Overall survival


Programmed-death 1


Progression-free survival


Randomized clinical trials


Tumor node metastasis



We thank Dr Marie-Laure Jullie, Pathology Department, CHU Bordeaux, France, for language editing of the manuscript.

Author contributions

All the authors had full access to all the data in the study. Manuscript was prepared by Vaianu Leroy, Emilie Gerard and Anne Pham-Ledard. Clinical data were prepared and interpreted by Vaianu Leroy, Emilie Gerard, Caroline Dutriaux, Sorilla Prey, Aurelia Gey, Marie Beylot-Barry, Cecile Mertens, and Anne Pham-Ledard. Marie Beylot-Barry and Anne Pham-Ledard reviewed the paper and provided important advice.


No relevant funding.

Compliance with ethical standards

Conflict of interest

Consulting and advisory role for Bristol-Myers Squibb (Dutriaux, Beylot-Barry); speaker honorarium (Pham-Ledard, Dutriaux, Beylot-Barry) travelling, expenses and accommodation (Pham-Ledard, Dutriaux, Beylot-Barry, Prey). All other authors declare that they have no conflict of interest.

Informed consent

A written informed consent was obtained from all individual participants included in the study, allowing authors to exploit data anonymously.

Ethical approval and ethical standards

This study has been approved by the ethics committee of the University Hospital of Bordeaux, reference number GP-CE2018/11, and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


  1. 1.
    Leroy V, Gerard E, Dutriaux C, Prey S, Gey A, Mertens C et al (2016) Tolérance et efficacité de l’ipilimumab chez les patients âgés. Ann Dermatol Venereol 143(Suppl 12):abstract:198CrossRefGoogle Scholar
  2. 2.
    Hodi FS, O’Day SJ, McDermott DF et al (2010) Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 363:711–723. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Schadendorf D, Hodi FS, Robert C et al (2015) Pooled analysis of long-term survival data from phase II and phase III trials of ipilimumab in unresectable or metastatic melanoma. J Clin Oncol 33:1889–1894. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Horvat TZ, Adel NG, Dang T-O et al (2015) Immune-related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at Memorial Sloan Kettering Cancer Center. J Clin Oncol 33:3193–3198. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kaehler KC, Piel S, Livingstone E et al (2010) Update on immunologic therapy with anti-CTLA-4 antibodies in melanoma: identification of clinical and biological response patterns, immune-related adverse events, and their management. Semin Oncol 37:485–498. CrossRefPubMedGoogle Scholar
  6. 6.
    Chiarion Sileni V, Pigozzo J, Ascierto PA et al (2014) Efficacy and safety of ipilimumab in elderly patients with pretreated advanced melanoma treated at Italian centres through the expanded access programme. J Exp Clin Cancer Res 33:30. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bertrand A, Kostine M, Barnetche T et al (2015) Immune related adverse events associated with anti-CTLA-4 antibodies: systematic review and meta-analysis. BMC Med 13:211. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Friedman CF, Wolchok JD (2017) Checkpoint inhibition and melanoma: considerations in treating the older adult. J Geriatr Oncol 8:237–241. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mian I, Yang M, Hui Z, Mohsin S, Adi D, Shannon V et al (2016) Immune related adverse events and survival in elderly patients with melanoma treated with ipilimumab, J Clin Oncol. CrossRefGoogle Scholar
  10. 10.
    Du-Thanh A, Lesage C, Ferreira E, Dereure O, Guillot B (2015) Innovative therapies for metastatic melanoma in elderly patients. Ann Dermatol Venereol 142:549–556. CrossRefPubMedGoogle Scholar
  11. 11.
    Elias R, Karantanos T, Sira E, Hartshorn KL (2017) Immunotherapy comes of age: immune aging and checkpoint inhibitors. J Geriatr Oncol 8(3):229–235. CrossRefPubMedGoogle Scholar
  12. 12.
    Nijhishima TF, Muss HB, Shachar SS, Moschos SJ (2016) Comparison of efficacy of immune checkpoint inhibitors (ICIs) between younger and older patients: a systematic review and meta-analysis. Cancer Treat Rev 45:30–37CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hôpital Saint André, service de DermatologieUniversity Hospital of BordeauxBordeauxFrance
  2. 2.Department of Clinical GerontologyUniversity Hospital of BordeauxBordeauxFrance
  3. 3.Univ. Bordeaux, INSERM U1053, Team 3 Oncogenesis of Cutaneous LymphomaBordeauxFrance

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