Melanoma Immunotherapy in the Elderly

The incidence of cutaneous melanoma in the elderly continues to rise. Immunotherapies such as the immune checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab have shown great promise in the management of this disease. There are growing data, mostly out of clinical trial experience, that shows the efficacy and tolerability of these agents across all ages, including those older than 75 years. Though at first glance immunotherapy for melanoma may appear to be a one-size fits all when it comes to age, a rationale is evolving for why this approach may warrant additional personalization in the older patient. This paper aims to summarize the clinical experience with these agents for elderly melanoma patients, as well as to introduce the concept of a personalized approach for elderly patients with consideration of incidence and management of side effects, and strategies for optimizing efficacy in the context of an aging immune system.