4321 - Health-related quality of life of advanced melanoma survivors treated with CTLA-4 immune checkpoint inhibition: a matched cohort study

Background

Since the introduction of immune-checkpoint blockade, the overall survival has significantly improved for patients with advanced melanoma. However, to date, there is limited data on patients’ functioning and health-related quality of life (HRQoL), years after active treatment. Therefore, we evaluated these outcomes in advanced melanoma survivors (AMS) and compared these with matched controls.

Methods

Ipilimumab-treated AMS without systemic treatment for at least 2 years were recruited from 15 hospitals. The primary outcome was HRQoL assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire-C30 (QLQ-C30). Secondary outcomes were fatigue, anxiety, depression and disease specific HRQoL. Up to 5 controls per AMS were individually matched on age, gender and educational status. Survivors and controls were compared on QLQ-C30 scores using generalized estimating equations. Differences in QLQ-C30 scores were classified as clinically important according to published guidelines.

Results

A total of 89 AMS were evaluated in this study. After last administration of ipilimumab, the mean follow-up (FU) was 45.5 (SD 20.8) months. Comparison with matched controls showed that AMS scored significantly lower on physical (difference (diff) = -5.80, p=.005), role (diff =-5.97, p=.02), cognitive (diff = -8.05, p=.001), and social functioning (diff = -8.49, p = <.001) and higher in symptom burden of fatigue (diff =7.48, p=.004), dyspnea (diff = 6.47, p=.02), diarrhea (diff = 3.78, p=.04) and financial impact (diff = 8.07, p=.001). Comparison between AMS with a FU ≥ 36 and FU < 36 months showed that social functioning, global QoL and financial impact scores were higher among the longer term survivors. Group differences in both analyses were clinically relevant.

Conclusions

Compared to matched controls, AMS showed overall worse functioning scores and more symptoms of fatigue, dyspnea, diarrhea and financial impact. AMS with a longer FU reported better QoL, but more financial issues. These study results may help to develop interventions to the individual healthcare needs of AMS and contribute to the development of appropriate survivorship care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Netherlands Cancer Institute.

Funding

Bristol-Myers Squibb.

Disclosure

All authors have declared no conflicts of interest.