Abstract:Purpose
Adjuvant treatment with immune checkpoint inhibitors like PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT) in high-risk melanoma patients demonstrate a significant improvement in disease-free survival (DFS). Due to specific side effects, the choice of treatment is very often driven by the risk for toxicity.
This study addressed for the first time in a multicenter setting the attitudes and preferences of melanoma patients for ad… Show more
“…1 ). Out of 165 patients who have been analyzed in a previous part of the study (Kähler et al 2023 ), 3 had to be excluded from analysis for different reasons. Regarding the analysis of the scenario ratings, between 11 and 25 patients had to be excluded, with n = 137 analyzable for the primary endpoint.…”
Section: Resultsmentioning
confidence: 99%
“… Fig. 1 Study flowchart represented included, excluded, and analyzed physicians in comparison to previously analyzed patients (Kähler et al 2023 ) …”
Section: Resultsmentioning
confidence: 99%
“…The group of physicians was compared with previously evaluated patients with low-risk melanoma, defined as T1a, at least 8 weeks after initial diagnosis, no sentinel node biopsy or significant co-morbidities (Kähler et al 2023 ). The rationale for low-risk melanoma patients was to choose a patient cohort with the experience of melanoma diagnosis, but not in the situation of having to decide for or against adjuvant treatment, to avoid ethical conflicts potentially induced by this study that may influence a patient’s decision.…”
Section: Methodsmentioning
confidence: 99%
“…The same data as previously for patients (Kähler et al 2023 ) were assessed in this second part of the study for physicians: preferences, socio-demographics, and self-experience with cancer.…”
Section: Methodsmentioning
confidence: 99%
“…We conducted a study to evaluate the attitudes of dermatooncologists towards toxicity during adjuvant treatment and compared the results with a patient cohort we previously evaluated in these melanoma centers (Kähler et al 2023 ). We aimed to identify any differences between melanoma patients and their treating physicians regarding the risk–benefit of adjuvant treatment in melanoma.…”
Introduction
Adjuvant treatment with immune checkpoint inhibitors, such as PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT), has shown a significant improvement in disease-free survival (DFS) for high-risk melanoma patients. However, due to specific side effects, the choice of treatment is often influenced by the risk of toxicity. Therefore, the role of physicians in treatment decisions of patients is crucial. This study investigated for the first time in a multicenter setting the attitudes and preferences of dermatooncologists in Germany and Switzerland regarding adjuvant treatment with (c)ICI and TT.
Methods
In the GERMELATOX-A study, 108 physicians (median age: 32 yrs, 67.6% female) from 11 skin cancer centers were surveyed to rate typical side effect scenarios of (c)ICI and TT treatments and then compared to patients’ ratings evaluated in a previous analysis from the same centers. The scenarios described mild-to-moderate or severe toxicity and included melanoma relapse leading to death. The physicians were asked about the level of side effects they would tolerate in exchange for a reduction in melanoma relapse and an increase in survival at 5 years.
Results
The preferences of physicians and patients revealed significant differences regarding adjuvant melanoma treatment with (c)ICI and TT (p < 0.05). Compared to patients, physicians tend to value a melanoma relapse less severe, according to a visual analog scale. They were also less threatened by all scenarios of side effects during adjuvant treatment with (c)ICI or TT, compared to patients. Physicians required lower risk reductions for disease-free survival (DFS) and overall survival (OS) for both ICI and TT and their drug-related side effects to accept these treatments. In case of severe side effects, physicians required similar 5-year DFS rates for ICI and TT (60–65%), while patients needed a 15% improvement of 5-year DFS for ICI compared to TT (80%/65%). For survival, physicians expected an OS improvement of + 10% for all three treatment modalities, whereas patients required a higher increase: + 18–22% for ICI and + 15% for TT.
Conclusion
Our study highlights the importance of understanding the patient’s perspective and a potential difference to the doctor’s view when making decisions about adjuvant melanoma treatment with (c)ICI and TT, especially as these treatments are increasingly being implemented in earlier stages.
“…1 ). Out of 165 patients who have been analyzed in a previous part of the study (Kähler et al 2023 ), 3 had to be excluded from analysis for different reasons. Regarding the analysis of the scenario ratings, between 11 and 25 patients had to be excluded, with n = 137 analyzable for the primary endpoint.…”
Section: Resultsmentioning
confidence: 99%
“… Fig. 1 Study flowchart represented included, excluded, and analyzed physicians in comparison to previously analyzed patients (Kähler et al 2023 ) …”
Section: Resultsmentioning
confidence: 99%
“…The group of physicians was compared with previously evaluated patients with low-risk melanoma, defined as T1a, at least 8 weeks after initial diagnosis, no sentinel node biopsy or significant co-morbidities (Kähler et al 2023 ). The rationale for low-risk melanoma patients was to choose a patient cohort with the experience of melanoma diagnosis, but not in the situation of having to decide for or against adjuvant treatment, to avoid ethical conflicts potentially induced by this study that may influence a patient’s decision.…”
Section: Methodsmentioning
confidence: 99%
“…The same data as previously for patients (Kähler et al 2023 ) were assessed in this second part of the study for physicians: preferences, socio-demographics, and self-experience with cancer.…”
Section: Methodsmentioning
confidence: 99%
“…We conducted a study to evaluate the attitudes of dermatooncologists towards toxicity during adjuvant treatment and compared the results with a patient cohort we previously evaluated in these melanoma centers (Kähler et al 2023 ). We aimed to identify any differences between melanoma patients and their treating physicians regarding the risk–benefit of adjuvant treatment in melanoma.…”
Introduction
Adjuvant treatment with immune checkpoint inhibitors, such as PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT), has shown a significant improvement in disease-free survival (DFS) for high-risk melanoma patients. However, due to specific side effects, the choice of treatment is often influenced by the risk of toxicity. Therefore, the role of physicians in treatment decisions of patients is crucial. This study investigated for the first time in a multicenter setting the attitudes and preferences of dermatooncologists in Germany and Switzerland regarding adjuvant treatment with (c)ICI and TT.
Methods
In the GERMELATOX-A study, 108 physicians (median age: 32 yrs, 67.6% female) from 11 skin cancer centers were surveyed to rate typical side effect scenarios of (c)ICI and TT treatments and then compared to patients’ ratings evaluated in a previous analysis from the same centers. The scenarios described mild-to-moderate or severe toxicity and included melanoma relapse leading to death. The physicians were asked about the level of side effects they would tolerate in exchange for a reduction in melanoma relapse and an increase in survival at 5 years.
Results
The preferences of physicians and patients revealed significant differences regarding adjuvant melanoma treatment with (c)ICI and TT (p < 0.05). Compared to patients, physicians tend to value a melanoma relapse less severe, according to a visual analog scale. They were also less threatened by all scenarios of side effects during adjuvant treatment with (c)ICI or TT, compared to patients. Physicians required lower risk reductions for disease-free survival (DFS) and overall survival (OS) for both ICI and TT and their drug-related side effects to accept these treatments. In case of severe side effects, physicians required similar 5-year DFS rates for ICI and TT (60–65%), while patients needed a 15% improvement of 5-year DFS for ICI compared to TT (80%/65%). For survival, physicians expected an OS improvement of + 10% for all three treatment modalities, whereas patients required a higher increase: + 18–22% for ICI and + 15% for TT.
Conclusion
Our study highlights the importance of understanding the patient’s perspective and a potential difference to the doctor’s view when making decisions about adjuvant melanoma treatment with (c)ICI and TT, especially as these treatments are increasingly being implemented in earlier stages.
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