Therapy understanding and health related quality of life in stage III/IV melanoma patients treated with novel adjuvant therapies

Abstract

Summary Objective Our aims were to investigate the motivation for therapy, the understanding and valuation of potential treatment toxicities in melanoma patients offered adjuvant therapies. Methods Between September 2018 and September 2019 49 adjuvant patients with stage III and IV melanoma received a self‐created, pre‐treatment questionnaire. Furthermore, the patients were handed out the REPERES‐G, EQ‐5D‐3L and EORTC QLQ C‐30 questionnaires. Results Eight patients (18.3 %) decided against adjuvant therapy (mean age 71.6 years). Four of these had stage IIIA melanoma. The majority of patients (73.4 %) decided for adjuvant treatment with PD1‐inhibitors despite their potential high grade, persistent, irreversible or even fatal toxicities. About a third of patients with BRAF V600 mutated melanoma who decided for therapy chose targeted therapy (31.3 %). These patients were younger (mean age 49 years), still working and had families with children. The REPERES‐G questionnaire showed that our patients were generally satisfied with medical care. The average scores in the EQ‐5D‐3L and EORTC QLQ C‐30 questionnaires indicated good subjective general health. Conclusions Despite the associated toxicities as well as the required time and effort for a one‐year treatment the majority of patients decided for adjuvant treatments.

Risk Stratification and Clinical Characteristics of Patients with Late Recurrence of Melanoma (>10 Years)

“…Risk scores from gene or immunohistochemical signatures have the potential to tailor adjuvant therapy independent of the histopathological criteria of the primary melanoma or the sentinel lymph node results. Acceptance rate of adjuvant therapies is high in stage III melanoma patients [ 37 ]. Additionally, further follow-up examinations after three years with lymph node sonography and computer tomography should be discussed in patients classified with high-risk scores.…”

Facial lipodystrophy after immunotherapy with Nivolumab

“…The publication and reporting of rare, adverse events in the appropriate registries will help to further improve handling of this group of substances. Providing patients with detailed information on adverse effects, which may be irreversible, is necessary to enable informed decision making and to further improve the acceptance of adjuvant immunotherapy [17].…”

Metastatic pigmented epithelioid melanocytoma in a 7‐year‐old female

“…Tumor deposits were detected in one of three lymph nodes, without signs of capsular invasion. This case was discussed in our interdisciplinary tumor board, and an off-label adjuvant anti-programmed cell death protein 1 (PD-1) monotherapy with pembrolizumab 2 mg/kg bodyweight every three weeks for one year was offered, despite potential side effects [4]. Thus far, the patient has received the first five doses and has tolerated the therapy well.…”