1595P - Incidence and characterization of end-of-life (EoL) systemic anticancer therapy (SACT) in melanoma patients (pts): A monocentric experience

Background

The administration of SACT in the last month of life represents an indicator of poor quality of care and exposes subjects to unbalanced side effects with limited therapeutic benefit. As a result, the overuse of SACT at the EoL is associated with higher rates of downstream acute care, delayed hospice care and higher costs. A recent evaluation on a cohort of unselected cancer pts showed an increased use of target agents (TA) and immunotherapy (IT) at the EoL, while chemotherapy (CT) has declined since 2015. Overall, SACT use rate was 39% within 30 days of death. Few data are available in melanoma population.

Methods

We retrospectively retrieved data on date of death and last SACT in a cohort of stage IV melanoma pts treated between January 2013 and December 2022 at the Oncology Unit of the University Hospital of Udine. Type of last SACT, occurrence of acute event (AE) and incidence of Hospital admission in the last 30 days were recorded.

Results

Overall, 140 pts treated with SACT for stage IV melanoma were included, with prevalence of male (64%) and BRAF mutated pts (60%). Fifty-five pts (39%) started a new SACT in the last three months of life and 36% of pts (51/140) received the last dose of SACT during the last 30 days. As last therapy, mono-IT was administered in nearly one third of pts (35%), TA in 41% and CT in 14% of pts. Twenty-seven (53%) patients had brain metastasis and 63% presented with more than 2 metastatic sites at last SACT administration. With regards to hospitalization rate, 70% (36/51) of pts treated in the last month was hospitalized with only 3 pts (8%) referred to the Palliative care Unit. The majority of subjects was admitted due to an AE (77%). Overall, the median survival from the last dose of SACT was 1,7 months.

Conclusions

In our cohort of melanoma pts the rate of SACT within the last 30 days of life was consistent with the historical literature data across all cancer type. However, we found a higher rate of hospital admission in the population who received a dose of SACT in the last months of life, compared to untreated population in that period (70% vs 42%). In accordance with the current therapeutic scenario, chemotherapy has been playing a limited role in advanced stage melanoma pts, as well in the EoL setting.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.