免疫检查点和 BRAF-MEK 抑制剂治疗转移性黑色素瘤患者的生存体验。
The survivorship experience for patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors.
机构信息
Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
出版信息
J Cancer Surviv. 2019 Aug;13(4):503-511. doi: 10.1007/s11764-019-00770-0. Epub 2019 Jun 4.
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.
目的
免疫检查点抑制剂（ICI）和 BRAF 和 MEK 抑制剂（BMi）改善了转移性黑色素瘤（MM）患者的生存。然而，长期应答者的经验仍未得到描述。本研究描述了 ICI 或 BMi 长期应答者面临的生存问题。
方法
本研究纳入了年龄≥18 岁、ICI 或 BMi 治疗后≥6 个月、有客观缓解或疾病稳定的 MM 患者。72 个问题的调查问卷评估了患者的身体和心理影响、对生活方式的影响、信息获取、对治疗的满意度和支持的可及性。
结果
120 例患者中有 105 例（88%）完成了调查（ICI 组 69 例，BMI 组 36 例）。ICI 组中，39 例（57%）正在接受持续治疗，17 例因毒性而停药，13 例因持续缓解而停药。BMI 组中，31 例（85%）正在接受持续治疗，4 例因毒性而停药，1 例因完全缓解而停药。截至 2018 年 12 月 18 日数据截止时，ICI 组和 BMI 组的中位 PFS（范围）分别为 2.5 年（1.3-8.5）和 3.1 年（0.6-7.3）。长期毒性包括干燥/瘙痒皮肤（ICI 组 51 例，74%/BMI 组 25 例，69%）、关节痛（ICI 组 30 例，58%/BMI 组 23 例，64%）和疲劳（ICI 组 62 例，90%/BMI 组 33 例，92%）。常见的心理困扰包括等待结果时的焦虑（ICI 组 50 例，72%/BMI 组 29 例，81%）、担心黑色素瘤复发或进展（ICI 组 56 例，81%/BMI 组 31 例，86%）或死亡（ICI 组 44 例，64%/BMI 组 26 例，72%）。
结论
MM 幸存者经历慢性治疗毒性，并经常报告心理问题。
对癌症幸存者的意义
幸存者可能受益于讨论长期毒性和定制的心理支持。
Zotero 插件