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

Abstract

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. Patients with MM, aged ≥ 18years old, ≥ 6months 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. One hundredand 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 2.5years (1.3-8.5) for ICI and 3.1years (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%). MM survivors experience chronic treatment toxicities and frequently report psychological concerns. Survivors may benefit from discussions regarding long-term toxicities and tailored psychological supports.