An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors

Abstract

Purpose The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achieving high-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aim of this study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-related adverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK. Methods We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durable response to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression. HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEs and survival. HRQoL data was compared with two norm-based datasets. Results Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity of any grade occurred in 92% of patients and 43% had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients required steroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyond steroids. Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical role functioning and general health compared with the normative population. There was a trend towards inferior scores in patients with previous exposure to ipilimumab compared with those never exposed to ipilimumab. Conclusions Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicity and experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population's unique survivorship needs.

Neurocognitive Function, Psychosocial Outcome, and Health-Related Quality of Life of the First-Generation Metastatic Melanoma Survivors Treated with Ipilimumab

“…In a large cohort study (N = 91) comparing IPI survivors with matched controls, Boekhout et al found decreased physical, role, cognitive, and social functioning as well as increased financial difficulties and fatigue symptoms according to the EORTC QLQ-C30 in IPI survivors [38]. These findings are in line with two recently published surveys, both reporting significant ICI toxicity, psychological concerns such as fear of melanoma recurrence, and impairments in specific HRQoL domains (emotional, physical, role, and social functioning) [38,39]. Cognitive function was not assessed with an objective NCF test battery.…”

Health-related quality of life of long-term advanced melanoma survivors treated with anti-CTLA-4 immune checkpoint inhibition compared to matched controls

“…Two other studies have evaluated patient-reported outcomes of advanced melanoma patients treated with ICI (ipilimumab and/or nivolumab or pembrolizumab). Using a non-cancer-specific measurement, O'Reilly et al [35] found that 73 patients had lower physical, social functioning, and general health levels, compared with an unmatched, normative population after a median follow-up of 25 months. These HRQoL results were established in 30% of patients on various ICI treatments.…”

Autoimmune complications of immunotherapy: pathophysiology and management

“…For example, in a study of 84 patients with metastatic melanoma who achieved a durable response to an ICI and had been followed for ≥12 months, patients had a statistically significantly lower health related quality of life with regard to physical, social, and physical role functioning and general health compared with population norms. Of these patients, 43% had experienced high grade irAEs and 14% had required treatment with an immunosuppressive agent in addition to corticosteroids 104. For those patients with durable remission from their cancer but left with a new chronic illness, including type 1 diabetes24 or chronic inflammatory arthritis,16 their quality of life is affected in the long term.…”