Quality of life in long-term survivors of advanced melanoma treated with checkpoint inhibitors

Abstract

BackgroundImmune checkpoint inhibitors (CIs) have revolutionized treatment of advanced melanoma, leading to an emerging population of long-term survivors. Survivors’ quality of life (QOL) and symptom burden are poorly understood. We set out to evaluate symptom burden and QOL in patients with advanced melanoma alive more than 1 year after initiating CI therapy.MethodsCross-sectional surveys, accompanied by chart review of patients with advanced melanoma treated with CIs at Memorial Sloan Kettering Cancer Center, completed therapy, and were alive >1 year after treatment initiation. Surveys were administered between February and August 2018. Surveys included: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, EuroQOL, items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events and Fatigue Severity Scale.ResultsWe included 90 patients. The most common CI regimens were ipilimumab plus nivolumab (53%) and pembrolizumab (41%); most patients (71%) were not treated in clinical trials. Median time from CI therapy initiation was 40 months and from last dose was 28 months. Fatigue was reported by 28%, with higher fatigue scores in women than men; 12% reported difficulty sleeping. Aching joints (17%) and muscles (12%) were fairly common. Level of functioning was generally high. Overall QOL was excellent though 40% reported ‘some or moderate’ problems with anxiety/depression and 31% with pain/discomfort.ConclusionsAfter CI therapy, long-surviving advanced melanoma patients commonly report fatigue but otherwise have moderate symptom burden and good QOL. Ensuring appropriate symptom management will optimize clinical outcomes for these patients.

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

“…As a result of the significant differences in methodology, study population and endpoints, a formal comparison between the three studies would not be appropriate. In a cross-sectional study in 90 advanced melanoma patients after completion of ICI treatment, fatigue was the most commonly reported symptom [37]. This study result is in line with our results with higher symptom burden of fatigue in the survivor population in comparison to the control population.…”

Real World Outcomes of Ipilimumab and Nivolumab in Patients with Metastatic Melanoma

“…The development of immunotherapeutic agents has drastically changed the outlook for melanoma patients over the past decade, significantly increasing survival rates and improving quality of life [ 1 , 2 , 3 , 4 , 5 ]. The anti-Cytotoxic T Lymphocyte Antigen (CTLA)-4 monoclonal antibody, ipilimumab, was the first immune checkpoint inhibitor approved for the treatment of unresectable melanoma [ 6 , 7 ], achieving relatively low response rates but meaningful long-term survival in one fifth of the patients, most of whom were still alive at the 10 year time-point [ 8 ].…”

Tumorassoziierte Fatigue bei Immuncheckpointinhibitoren

“…Während für die immunologisch bedingten organbezogenen Nebenwirkungen der ICI Leitlinien für das Management vorliegen [ 11 , 19 ], muss die Behandlung der CRF, die auch Langzeitfolge sein kann [ 16 ], individualisiert und patientenzentriert erfolgen.…”

“…Tab. 1 Mögliche Ursachen, Einfluss-und Risikofaktoren für tumorassoziierte Fatigue ("cancer-related fatigue", CRF; s. [7,13,18 Während für die immunologisch bedingten organbezogenen Nebenwirkungen der ICI Leitlinien für das Management vorliegen [11,19], muss die Behandlung der CRF, die auch Langzeitfolge sein kann [16], individualisiert und patientenzentriert erfolgen.…”