Skip to main content
SSO 2026 Annual Meeting Main banner

BP2. Adjuvant anti-PD-1 therapy in elderly patients with melanoma: an analysis of the Sentinel Lymph Node Working Group cohort

Friday, March 6, 2026
8:09 AM - 8:16 AM MST
Location: 301A
Introduction: Older age at melanoma diagnosis is associated with worse melanoma-specific survival (MSS) and more aggressive tumor biology, yet elderly patients are less likely to receive adjuvant immunotherapy. Subgroup analyses from randomized trials of anti-PD-1 monotherapy have yielded mixed results regarding recurrence-free survival (RFS) benefit in the elderly. We evaluated real-world RFS among elderly patients with sentinel lymph node (SLN)-positive melanoma, hypothesizing that anti-PD-1 therapy would have similar RFS benefit in older as in younger patients.


Methods: The Sentinel Lymph Node Working Group database was queried to identify adults with SLN-positive melanoma between January 2017 and December 2023. Data from 13 institutions were included. Patients received adjuvant anti-PD-1 monotherapy or no immunotherapy. Those with clinically detected nodal metastasis, distant metastasis, incomplete staging, or neoadjuvant immunotherapy were excluded. The cohort was dichotomized into younger ( < 75 years) and older ( > 75 years) subgroups. Cox proportional hazards (PH) models assessed RFS and MSS.


Results: Of 960 eligible patients, 752 (78.3%) were < 75 years, and 208 (21.7%) were > 75 years. Median age was 63 years (IQR 51-73 years). 465 younger patients (61.8%) and 92 older patients (44.2%) received adjuvant anti-PD-1 therapy (p < 0.001). Over a median follow-up of 32.2 months (IQR 14.4-52.5 months), 25.0% of younger patients and 34.6% of older patients experienced recurrence. In Cox PH analysis of the entire cohort, lymphovascular invasion and increasing T and N stage were associated with worse RFS, while receipt of anti-PD-1 monotherapy predicted improved RFS (p < 0.001). After stratification by age, receipt of anti-PD-1 monotherapy conferred a significant RFS benefit in patients < 75 years (HR 0.70; 95% CI 0.49-0.99), but in patients > 75 years, adjuvant therapy was not associated with RFS improvement (HR 0.94; 95% CI 0.54-1.63). Adjuvant therapy showed no impact on MSS in either age group.


Conclusions: In this multi-institutional, real-world experience with adjuvant anti-PD-1 therapy for melanoma, treatment improved RFS for younger patients but not in older patients. No MSS benefit was observed for either group.

Learning Objectives:

  • Describe tumor-level factors predicting RFS in younger and older patients.
  • Evaluate real-world oncologic outcomes (RFS and MSS) of adjuvant anti-PD-1 monotherapy by age group in patients with SLN-positive melanoma.