Managing Checkpoint Inhibitor Symptoms and Toxicity for Metastatic Melanoma

Pavlick, Anna C.; Weber, Jeffrey S.

doi:10.1007/978-3-030-05070-2_60

Cited by 2 publications

(2 citation statements)

References 232 publications

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“…Our study focused on older adults with 85% having pre-existing multimorbidity who may be at high risk for poor survival prognosis. As evidence is still emerging on the side effect profile of ICIs compared to existing modalities, [ 27 ] oncologists may be cautious in using ICI among older patients with late-stage melanoma.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma

et al. 2021

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Improvement in overall survival by immune checkpoint inhibitors (ICI) treatment in clinical trials encourages their use for late-stage melanoma. However, in the real-world, heterogeneity of population, such as older patients with multimorbidity, may lead to a slower diffusion of ICIs. The objective of this study was to examine the association of multimorbidity and other factors to ICI use among older patients with late-stage melanoma using real world data. A retrospective cohort study design with a 12-month baseline and follow-up period was adopted with data from the linked Surveillance, Epidemiology, and End Results cancer registry/Medicare database. Older patients (>65 years) with late-stage (stage III/IV) melanoma diagnosed between 2012 and 2015 were categorized as with or without multimorbidity (presence of 2 or more chronic conditions) and ICI use was identified in the post-index period. Chi-square tests and logistic regression were used to evaluate factors associated with ICI use. In the study cohort, 85% had multimorbidity, 18% received any treatment (chemotherapy, radiation, and/or ICI), and 6% received ICI. Only 5.5% of older patients with multimorbidity and 6% without multimorbidity received ICIs. Younger age, presence of social support, lower economic status, residence in northeastern regions, and recent year of diagnosis were significantly associated with ICI use; however, multimorbidity, sex, and race were not associated with ICI use. In the real-world clinical practice, only 1 in 18 older adults with late stage melanoma received ICI, suggesting slow pace of diffusion of innovation. However, multimorbidity was not a barrier to ICI use.

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Section: Discussionmentioning

confidence: 99%

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma

et al. 2021

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“…Underdiagnosis, a missed or delayed melanoma diagnosis, leading to untreated or improperly treated disease, is a familiar problem to clinicians. This is particularly undesirable in melanoma, where a correct early diagnosis often allows successful treatment with a simple excision, while advanced melanoma treatment is expensive and associated with a poorer prognosis and undesirable side effects of treatment ( 6 , 7 ). Medico-legal fears also incline clinicians to excise rather than monitor a suspicious lesion and patients often express a preference for an early excision ( 5 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

The Future of Precision Prevention for Advanced Melanoma

et al. 2022

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Precision prevention of advanced melanoma is fast becoming a realistic prospect, with personalized, holistic risk stratification allowing patients to be directed to an appropriate level of surveillance, ranging from skin self-examinations to regular total body photography with sequential digital dermoscopic imaging. This approach aims to address both underdiagnosis (a missed or delayed melanoma diagnosis) and overdiagnosis (the diagnosis and treatment of indolent lesions that would not have caused a problem). Holistic risk stratification considers several types of melanoma risk factors: clinical phenotype, comprehensive imaging-based phenotype, familial and polygenic risks. Artificial intelligence computer-aided diagnostics combines these risk factors to produce a personalized risk score, and can also assist in assessing the digital and molecular markers of individual lesions. However, to ensure uptake and efficient use of AI systems, researchers will need to carefully consider how best to incorporate privacy and standardization requirements, and above all address consumer trust concerns.

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Managing Checkpoint Inhibitor Symptoms and Toxicity for Metastatic Melanoma

Cited by 2 publications

References 232 publications

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma

The Future of Precision Prevention for Advanced Melanoma

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