The survivorship experience of patients with metastatic melanoma on long-term immune checkpoint inhibitors

Date 25 November 2018
Event ESMO Asia 2018 Congress
Session Mini Oral - Melanoma and Sarcoma
Topics Melanoma
Immunotherapy
Survivorship
Presenter Julia Lai-Kwon
Citation Annals of Oncology (2018) 29 (suppl_9): ix105-ix108. 10.1093/annonc/mdy439
Authors J.E. Lai-Kwon1, C. Khoo1, S. Lo2, D. Milne3, M. Mohamed3, J. Raleigh4, K. Smith1, K. Lisy3, S.K. Sandhu1, M. Jefford1
  • 1Department Of Medical Oncology, Peter MacCallum Cancer Centre, 3000 - Melbourne/AU
  • 2Melanoma Institute Australia, University of Sydney, 2065 - Wollstonecraft/AU
  • 3Department Of Cancer Experiences Research, Peter MacCallum Cancer Centre, 3000 - Melbourne/AU
  • 4Research Division, Peter MacCallum Cancer Centre, 3000 - Melbourne/AU

Abstract

Background

Immune checkpoint inhibitors (ICI) have improved survival for a proportion of patients (pts) with metastatic melanoma (MM). This has resulted in a cohort of long-term responders whose survivorship experience remains virtually undescribed. We characterised survivorship issues faced by these pts using a cross-sectional survey.

Methods

Eligible pts had MM, aged >18, ≥ 6 months post initiation of ICI, and attained an objective response or stable disease at the time of enrolment. A 72-item questionnaire including items from validated measures and customised questions covering physical and psychological effects, impact on lifestyle, access to information, and availability of supports was administered. The impact of treatment status (on vs off) and duration on ICI (<12 or > 12 months) was assessed.

Results

105/120 pts (88%) responded from August-December 2017. 69 received ICI [median age 63 (range 24-88); 42 (61%) male; 49 (71%) on 1st line therapy]. 39 (56%) were on treatment. 30 (43%) were off treatment – 63% due to toxicity, 23% due to completion of induction ipilimumab, 13% due to a sustained response with two years of anti-PD1 therapy. 41 (59%) reported at least 1 long-term toxicity due to treatment. The most common physical symptoms were fatigue (62, 90%), dry/itchy skin (51, 74%) and arthralgias (30, 58%). The prevalence and severity of symptoms were similar regardless of treatment status or duration on treatment. Psychological morbidity was common including concerns about stopping treatment (50, 86%) and the long-term side effects of ICI (51, 74%), and anxiety awaiting results (50, 72%). Fear of cancer recurrence (FCR) was prevalent (56, 81%). Pts reported difficulties with domestic tasks (36, 52%) and recreational activities (43, 62%). Most valued a survivorship care plan (SCP) (63, 91%) and screening for other cancers (67, 97%).

Conclusions

The clinical focus in long-term survivors of MM needs to shift towards the early identification of patient concerns and unmet needs, and the development of appropriate resources to manage these issues. Pts may benefit from regular discussions regarding ICI treatment duration and long term toxicities, tailored psychological support and a SCP with recommendations for screening.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Peter MacCallum Cancer Centre.

Funding

Skin and Melanoma Unit, Peter MacCallum Cancer Centre.

Disclosure

D. Milne: Honoraria, Consulting/advisory roles: MSD, BMS, Novartis; Research Funding Merck. S.K. Sandhu: Honorarium for advisory board: Merck, BMS, Genetech. M. Jefford: Travel assistance: Roche, 2018. All other authors have declared no conflicts of interest.