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The survivorship experience for patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors

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Abstract

Purpose

Immune checkpoint inhibitors (ICI) and BRAF and MEK inhibitors (BMi) have improved survival in metastatic melanoma (MM). However, the experience of long-term responders remains undescribed. This study characterised survivorship issues faced by long-term responders to ICI or BMi.

Methods

Patients with MM, aged ≥ 18 years old, ≥ 6 months post-ICI or BMi initiation with an objective response or stable disease. A 72-question survey assessed physical and psychological effects, impact on lifestyle, access to information, satisfaction with care, and availability of supports.

Results

One hundred and five of 120 (88%) patients completed the survey (ICI 69/BMI 36). For the ICI cohort, 39 (57%) were receiving ongoing treatment, 17 ceased due to toxicity and 13 due to a sustained response. For the BMi cohort, 31 (85%) were receiving ongoing treatment, 4 ceased due to toxicity and 1 due to a sustained complete response. At data cut-off on 18 December 2018, median PFS (range) was 2.5 years (1.3–8.5) for ICI and 3.1 years (0.6–7.3) for BMi. Long-term toxicities included dry/itchy skin (ICI 51, 74%/ BMi 25, 69%), arthralgias (ICI 30, 58%/ BMi 23, 64%) and fatigue (ICI 62, 90%/ BMi 33, 92%). Psychological morbidity was common, including anxiety awaiting results (ICI 50, 72%/ BMi 29, 81%), fear of melanoma recurring or progressing (ICI 56, 81%/ BMi 31, 86%) or death (ICI 44, 64%/ BMi 26, 72%).

Conclusion

MM survivors experience chronic treatment toxicities and frequently report psychological concerns.

Implications for Cancer Survivors

Survivors may benefit from discussions regarding long-term toxicities and tailored psychological supports.

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Acknowledgements

We would like to thank the Skin and Melanoma Service at Peter MacCallum Cancer Centre for their support with patient enrolment and data collection, and the Melanoma Research Victoria Consumer Group for reviewing the questionnaire.

Funding

This work was financially supported by a Research Grant from the Skin and Melanoma Service, Peter MacCallum Cancer Centre.

Author information

Author notes

  1. Julia Lai-Kwon and Chloe Khoo are joint first authors.  Shahneen Sandhu and Michael Jefford are joint senior authors.

Authors and Affiliations

  1. Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia

    Julia Lai-Kwon, Chloe Khoo, Kortnye Smith, Shahneen Sandhu & Michael Jefford

  2. Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia

    Serigne Lo

  3. Institute for Research and Medical Consultations, University of Dammam, Dammam, Kingdom of Saudi Arabia

    Serigne Lo

  4. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia

    Donna Milne, Mustafa Mohamed, Karolina Lisy & Michael Jefford

  5. Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia

    Jeanette Raleigh

  6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia

    Michael Jefford

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Correspondence to Michael Jefford.

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Conflict of interest

CK has received travel assistance from Roche. DM has received honoraria and consultancy fees from Bristol-Myers Squibb, MSD and Novartis, and institutional research funding from Merck. SS has received honoraria and consultancy fees from Bristol-Myers Squibb and Merck. MJ has received travel assistance from Roche. All remaining authors have declared no conflicts of interest.

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All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Lai-Kwon, J., Khoo, C., Lo, S. et al. The survivorship experience for patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors. J Cancer Surviv 13, 503–511 (2019). https://doi.org/10.1007/s11764-019-00770-0

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