Health-related quality of life, emotional burden, and neurocognitive function in the first generation of metastatic melanoma survivors treated with pembrolizumab: a longitudinal pilot study

Rogiers, Anne; Leys, Christophe; Cremer, Jennifer; Awada, Gil; Schembri, Adrian; Theuns, Peter; Ridder, Mark De; Neyns, Bart

doi:10.1007/s00520-019-05168-3

Cited by 36 publications

(27 citation statements)

References 42 publications

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“…Posttraumatic stress disorder was present in one-third of the survivors and was related to the moment of receiving a diagnosis of incurable cancer, the traumatic course of disease progression, or the occurrence of irAEs. This is in accord with our previous findings in short-term survivors treated with pembrolizumab as well as with the results of a meta-analysis, where Abbey et al reported that cancer diagnosis and treatment can induce PTSD [ 9 , 31 ]. Younger age, completion of treatment, and more advanced disease were found to be associated with a higher risk for developing PTSD [ 36 ].…”

Section: Discussionsupporting

confidence: 93%

“…Impairment in subjective cognition was associated more strongly with levels of fatigue, anxiety, and depressive symptoms. The high proportion of survivors with impairment in NCF as well as the discrepancy between impairment in subjective cognition and impairment in NCF is also consistent with our previous observations made in short-term metastatic melanoma survivors (in remission since 6 months) treated with the anti-PD1 immune checkpoint inhibitor, pembrolizumab [31].…”

Section: Discussionsupporting

confidence: 91%

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

Rogiers

Leys

Lauwyck

et al. 2020

Journal of Immunology Research

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Purpose. To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of life (HRQoL), and long-term effects of immune-related adverse events (irAE) on metastatic melanoma survivors treated with ipilimumab (IPI). Methods. Melanoma survivors were identified within two study populations (N=104), at a single-center university hospital, and defined as patients who were disease-free for at least 2 years after initiating IPI. Data were collected using 4 patient-reported outcome measures, computerized NCF testing, and a semistructured interview at the start and 1-year follow-up. Results. Out of 18 eligible survivors, 17 were recruited (5F/12M); median age is 57 years (range 33-86); and median time since initiating IPI was 5.6 years (range 2.1-9.3). The clinical interview revealed that survivors suffered from cancer-related emotional distress such as fear of recurrence (N=8), existential problems (N=2), survivor guilt (N=2), and posttraumatic stress disorder (N=6). The mean EORTC QLQ-C30 Global Score was not significantly different from the European mean of the healthy population. Nine survivors reported anxiety and/or depression (Hospitalization Depression Scale) during the survey. Seven survivors (41%) reported fatigue (Fatigue Severity Scale). Seven patients (41%) had impairment in NCF; only three out of seven survivors had impairment in subjective cognition (Cognitive Failure Questionnaire). Anxiety, depression, fatigue, and neurocognitive symptoms remained stable at the 1-year follow-up. All cases of skin toxicity (N=8), hepatitis (N=1), colitis (N=3), and sarcoidosis (N=1) resolved without impact on HRQoL. Three survivors experienced hypophysitis; all suffered from persistent fatigue and cognitive complaints 5 years after onset. One survivor who experienced a Guillain-Barré-like syndrome suffered from persisting depression, fatigue, and impairment in NCF. Conclusion. A majority of melanoma survivors treated with IPI continue to suffer from emotional distress and impairment in NCF. Timely detection in order to offer tailored care is imperative, with special attention for survivors with a history of neuroendocrine or neurological irAE. The trial is registered with B.U.N. 143201421920.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

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

Rogiers

Leys

Lauwyck

et al. 2020

Journal of Immunology Research

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“…After this period, the progression risk gradually decreases and about 23.0-29.0% of patients will remain free from progression at five years following treatment initiation [1][2][3]. Moreover, patients who electively discontinue therapy are at low risk for subsequent progression of disease [4][5][6]. The risk for progression after elective discontinuation likely correlates with the quality of the response, as patients with a complete response (CR) on computed tomography (CT) or complete metabolic response (CMR) on 18-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) have the lowest risk of progression, while patients with partial response (PR), stable disease (SD), or non-CMR as best response are more likely to progress during follow-up [4,5,7].…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Analysis of Baseline Clinical Characteristics and Biomarkers Associated with Outcome in Advanced Melanoma Patients Treated with Pembrolizumab

Awada

Jansen

Schwarze

et al. 2021

Cancers

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Background: Pembrolizumab improves the survival of patients with advanced melanoma. A comprehensive analysis of baseline variables that predict the benefit of pembrolizumab monotherapy has not been conducted. Methods: Survival data of patients with advanced melanoma who were treated with pembrolizumab in a single university hospital were collected. A multivariate Cox regression analysis was performed to correlate baseline clinical, laboratory, and radiologic characteristics and NanoString IO360 gene expression profiling (GEP) with survival. Results: 183 patients were included (stage IV 85.2%, WHO performance status ≥1 31.1%; pembrolizumab first-line 25.7%), of whom 112 underwent baseline 18F-FDG-PET/CT imaging, 58 had circulating tumor DNA (ctDNA) assessments, and GEP was available in 27 patients. Active brain metastases, a higher number of metastatic sites, lower albumin and absolute lymphocyte count (ALC), higher C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio, higher total metabolic tumor volume (TMTV), and higher ctDNA levels were associated with worse survival. Elevated lactate dehydrogenase (LDH) ≥ 2ULN (upper limit of normal), CRP ≥ 10ULN, or ALC < 750/mm3 delineate a subpopulation where treatment with pembrolizumab is futile. A TMTV ≥ 80 mL encompassed 17/21 patients with LDH ≥ 2ULN, CRP ≥ 10ULN, or ALC < 750/mm3. No significant associations were observed between baseline GEP scores and survival. Conclusion: Multiple baseline variables correlate with survival on pembrolizumab. TMTV is a more comprehensive baseline biomarker than CRP, LDH, or ALC in predicting the futility of pembrolizumab.

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“…In addition to these physical symptoms, a study of patients with metastatic melanoma treated with pembrolizumab demonstrated that approximately one third of patients had cognitive impairment. 25 Targeted therapies, which are primarily tyrosine kinase inhibitors, are also associated with new toxicities including diarrhea, dermatologic symptoms, elevated liver function tests, and edema, although later generation agents carry lower risk of these side effects. 26 Several newer targeted therapies have tumor responses in the brain (eg, lorlatinib), which can have central nervous system effects including sleep disturbance, hallucinations, and suicidal ideation.…”

Section: Managing Novel Side Effect Profilesmentioning

confidence: 99%

Patient-Centered Palliative Care for Patients With Advanced Lung Cancer

Temel

Petrillo

Greer

2022

JCO

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The evidence base demonstrating the benefits of an early focus on palliative care for patients with serious cancers, including advanced lung cancer, is substantial. Early involvement of specialty-trained palliative care clinicians in the care of patients with advanced lung cancer improves patient-reported outcomes, such as quality of life, and health care delivery, including hospice utilization. Since the time that many of these palliative care trials were conducted, the paradigm of cancer care for many cancers, including lung cancer, has changed dramatically. The majority of patients with advanced lung cancer are now treated with immune checkpoint inhibitors or targeted therapies, both of which have had a significant impact on patient's experience and outcomes. With this changing landscape of lung cancer therapeutics, patients are facing new and different challenges, including dealing with novel side effect profiles and coping with greater uncertainty regarding their prognosis. Patients who are living longer with their advanced cancer also struggle with how to address survivorship issues, such as sexual health and exercise, and decision making about end-of-life care. Although palliative care clinicians remain well-suited to address these care needs, they may need to learn new skills to support patients treated with novel therapies. Additionally, as the experience of patients with advanced lung cancer is becoming more varied and individualized, palliative care research interventions and clinical programs should also be delivered in a patient-centered manner to best meet patient's needs and improve their outcomes. Tailored and technology-based palliative care interventions are promising strategies for delivering patient-centered palliative care.

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Health-related quality of life, emotional burden, and neurocognitive function in the first generation of metastatic melanoma survivors treated with pembrolizumab: a longitudinal pilot study

Cited by 36 publications

References 42 publications

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

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

A Comprehensive Analysis of Baseline Clinical Characteristics and Biomarkers Associated with Outcome in Advanced Melanoma Patients Treated with Pembrolizumab

Patient-Centered Palliative Care for Patients With Advanced Lung Cancer

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