1107P - Characteristics and quality of life of nine-year survivors from 312 patients with metastatic melanoma treated with pembrolizumab

Background

Immune checkpoint blockers (ICB) have improved overall survival of metastatic melanoma patients. Therefore, quality of life and long-term sequelae from ICB induced immune-related adverse events (irAE) are of importance.

Methods

13 German skin cancer centers evaluated survival of melanoma patients that started pembrolizumab before 07/2015 after progression with at that time standard of care agents (ipilimumab, BRAF/MEK inhibition, chemotherapy). The number of melanoma survivors, deaths and patients lost to follow-up was assessed. For surviving patients baseline characteristics, efficacy and irAE under therapy were collected. Patients were interviewed about current symptoms and quality of life.

Results

From 312 treated patients 231 (74%) have died, 28 (9%) were lost to follow-up and 53 (17%) are still alive after a median follow-up of 9.1 years from treatment start. In this surviving cohort (n=53), baseline characteristics were: 31 (58%) male, median age 60 (range 27-76), 35 (66%) ECOG 0, 21 (40%) BRAFV600E/K mutated, 35 (66%) M1c/d stage, 23 (43%) with elevated LDH and a median number of 2 pretreatments (range 1-6). Survivors showed an overall response rate of 91% with 37 complete responses (CR, 70%). 21 (40%) patients eventually progressed with subsequent treatments being mainly ICB (18) and local therapies (10). As of January 2024, 45 (85%) patients are without evidence of disease and 6 (11%) with controlled disease. Concerning toxicity, 38 (72%) experienced irAE under therapy, 15 (28%) of grade 3/4. After now almost 10 years, 18 (34%) patients state persisting symptoms, mainly vitiligo (4), hypothyroidism (4), pituitary/adrenal gland insufficiency (3) and fatigue (3). Of 23 patients still in working age, 8 (35%) were not able to work anymore. However, quality of life as measured by median WHO-5 score was 19 (76%) which is above the mean scores for the general population in Germany.

Conclusions

Pembrolizumab induced long-term survival in 17% of patients with pretreated metastatic melanoma in a real-world setting, most of them responded to pembrolizumab with a CR. Permanent sequela from immunotherapy were noted, however, quality of life was good in most patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

J. Hassel.

Funding

Has not received any funding.

Disclosure

J.C. Hassel: Financial Interests, Personal, Invited Speaker: BMS, Novartis, Sanofi, MSD, SunPharma, Amgen, GSK, Pierre Fabre, Immunocore, Delcath; Financial Interests, Institutional, Advisory Board: MSD, Novartis, BMS, Immunocore, Philogen, Sanofi; Financial Interests, Personal, Advisory Board: Pierre Fabre, SunPharma, GSK, Onkowissen, Pierre Fabre; Financial Interests, Institutional, Writing Engagement: BMS; Financial Interests, Institutional, Research Grant: BMS, SunPharma, Sanofi; Financial Interests, Institutional, Local PI: Philogen, Genentech, 4SC, BioNTech, Iovance, Pierre Fabre, Regeneron, Sanofi, Replimune, Immatics, MSD, Pfizer, Agenus; Financial Interests, Institutional, Coordinating PI: BMS, Immunocore, Novartis, Genmab, Seagan; Financial Interests, Personal, Steering Committee Member: Immunocore, IO Biotech; Non-Financial Interests, Leadership Role: DeCOG; Non-Financial Interests, Member: ASCO. A. Forschner: Financial Interests, Institutional, Advisory Board: Novartis, MSD, BMS, Pierre Fabre, Immunocore; Financial Interests, Institutional, Invited Speaker: Immunocore, Novarits, BMS, Pierre Fabre; Financial Interests, Institutional, Research Grant: BMS Immunoncology; Non-Financial Interests, Member: ADO, DKG, PSO, DDG; Non-Financial Interests, Leadership Role: ADO Komitee Survivorship; Other, Other, congress participation including travel and hotel: Pierre Fabre. M. Erdmann: Financial Interests, Personal, Advisory Board, Clinical case presentation: Immunocore; Financial Interests, Personal, Invited Speaker, Presentation at workshop for nurses: Novartis; Financial Interests, Personal, Invited Speaker, Presentation at workshop as well as travel/meeting expenses: Pierre Fabre; Financial Interests, Personal, Other, travel expenses: Sanofi. R. Gutzmer: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Pierre Fabre, Novartis, MSD, Merck Serono, Almirall, Immunocore, Delcath, KyowaKirin, Sanofi/Regeneron, SUN Pharma; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb, Pierre Fabre, Novartis, MSD, Merck Serono, Almirall, Sanofi/Regeneron, SUN Pharma; Financial Interests, Institutional, Research Grant: KyowaKirin, Almirall, SUN Pharma, Amgen, Sanofi/Regeneron, Merck Serono; Non-Financial Interests, Member of Board of Directors: DeCOG; Other, Other, Travel and meeting support: Pierre Fabre, SUN Pharma. K.C. Kähler: Financial Interests, Advisory Board: BMS, MSD, Pierre Fabre, Roche, Immunocore, Regeneron, Sanofi-Aventis, Delcath; Financial Interests, Research Funding: MSD, Immunocore, Huya-Biosciences, BMS, Roche, Sanofi-Aventis, Pierre Fabre. H. Stege: Financial Interests, Invited Speaker: BMS, MSD, SunPharma, Pierre Fabre. C. Franklin: Financial Interests, Personal, Advisory Board: BMS, Pierre Fabre, Novartis. A. Sindrilaru: Financial Interests, Personal, Advisory Board, consulting: MSD, BMS, Pierre Fabre, Novartis; Financial Interests, Personal, Invited Speaker, Speaker fee at regional conferences: Sanofi / Regeneron; Financial Interests, Personal, Invited Speaker, speaker fee, travel expenses: Immunocore; Financial Interests, Personal, Advisory Board, consulting and speaker fee: SunPharma; Financial Interests, Personal, Invited Speaker, speaker fee at regional conferences: Kyowa Kirin, Takeda; Non-Financial Interests, Principal Investigator, clinical trial: MSD, BMS, Huyabio, Regeneron, Pierre Fabre. L. Zimmer: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Novartis, MSD, SunPharma, Pierre Fabre, Sanofi; Financial Interests, Personal, Other, Travel Support: Bristol Myers Squibb, MSD, SunPharma, Pierre Fabre, Sanofi, Novartis, Amgen; Financial Interests, Personal, Invited Speaker: Novartis, MSD, Pierre Fabre, Roche; Financial Interests, Personal and Institutional, Research Grant: Novartis; Non-Financial Interests, Member: German Cancer Society, Dermatologic Cooperative Oncology Group. L. Heinzerling: Financial Interests, Personal, Advisory Board: Amgen, BiomeDx BMS, CureVac AG, Kyowa Kirin, MSD, Novartis, Roche, Sanofi, SunPharma, Therakos; Financial Interests, Institutional, Research Funding: Agenus, AstraZeneca, BioMedX, BMS, EORTC, Roche, Genentech, Huya Bioscience, Immunocore, IOBiotech, Merck, MSD, Miltenyi, Novartis, Pfizer, Pierre Fabre, Regeneron, Replimune, Sanofi-Aventis. J. Utikal: Financial Interests, Personal, Advisory Board: Amgen, Bristol Myers Squibb, Immunocore, Merck Sharp and Dohme, Novartis, Pierre Fabre, Rheacell, Sanofi. F. Meier: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Novartis, MSD, Sanofi, Philogen, Immunocore; Financial Interests, Personal, Invited Speaker: Sanofi, Immunocore. C. Berking: Financial Interests, Personal, Advisory Board: BMS, MSD, InflaRx, Sanofi, Regeneron, Novartis, Pierre Fabre, Delcath, Immunocore; Financial Interests, Personal, Invited Speaker: BMS, Almirall, MSD, Immunocore, Pierre Fabre, Leo Pharma; Financial Interests, Institutional, Coordinating PI: Almirall; Financial Interests, Institutional, Local PI: InflaRx, Immunocore, IOBiotech, Kartos, MSD, Regeneron. C. Garbe: Financial Interests, Personal, Advisory Board: CeCaVa, MSD, NeraCare, Philogen; Non-Financial Interests, Leadership Role, President: European Association of Dermatooncology (EADO). M. Weichenthal: Financial Interests, Personal, Advisory Board: MSD, Bristol Myers and Squibb, Sun Pharma, Sanofi, Pierre Fabre; Financial Interests, Institutional, Local PI: Millennium, Merck Sharp & Dohme, 4SC, Innate Pharma; Financial Interests, Institutional, Research Grant: Bristol Myers and Squibb, Novartis; Non-Financial Interests, Leadership Role: EUMelaReg; Non-Financial Interests, Member of Board of Directors: DeCOG. D. Schadendorf: Financial Interests, Personal, Invited Speaker: BMS, MSD, Merck Serono, Sanofi, Neracare, SunPharma; Financial Interests, Personal, Advisory Board: BMS, Novartis, MSD, Immunocore, Pierre Fabre, Sanofi/Regeneron, Pfizer, Philogen, Neracare, InFlarX, BioAlta, Daiichi Sanyko, NoviGenix, Anaveon, AstraZeneca, PamGene, BioNTech, Immatics, CureVac, Erasca, Formycon, Replimune, Seagen, SunPharma, Ultimovacs; Financial Interests, Personal, Steering Committee Member: Novartis, BMS, MSD; Financial Interests, Institutional, Coordinating PI: Novartis, BMS, MSD, Pierre Fabre; Financial Interests, Institutional, Research Grant: BMS, MSD; Financial Interests, Institutional, Local PI: Sanofi, Philogen; Non-Financial Interests, Member of Board of Directors: EORTC-MG; Non-Financial Interests, Leadership Role, Founding member and SC chair: European Melanoma Registry (EuMelaReg). A. Hauschild: Financial Interests, Personal, Advisory Board: BMS, MSD, Philogen, Pierre Fabre, Regeneron, Roche, Sanofi, Novartis, Eisai, Immunocore, Replimune, Seagen, Dermagnostix, Neracare, IO Biotech, Incyte, Highlight Therapeutics, Agenus, Xenthera; Financial Interests, Personal, Invited Speaker: Merck Pfizer; Financial Interests, Institutional, Local PI: BMS, MSD, Pierre Fabre, Amgen, Roche, Agenus; Financial Interests, Institutional, Coordinating PI: Regeneron, Novartis. P. Mohr: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Merck Sharp & Dohme, Merck Sharp & Dohme, Novartis, GSK, Pierre Fabre, Sanofi; Financial Interests, Personal, Invited Speaker: Amgen, Bristol Myers Squibb, Merck Sharp & Dohme, Merck Sharp & Dohme, Novartis, Roche, Pierre Fabre, Sanofi, Sun Pharma; Financial Interests, Institutional, Funding: Bristol Myers Squibb, Merck Sharp & Dohme, Novartis; Non-Financial Interests, Principal Investigator: Bristol Myers Squibb, Merck Sharp & Dohme, Regeneron, Sanofi, Novartis, Sun Pharma. All other authors have declared no conflicts of interest.