Department of Psychiatry, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.
J Immunol Res. 2020 Jul 21;2020:2192480. doi: 10.1155/2020/2192480. eCollection 2020.
To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of life (HRQoL), and long-term effects of immune-related adverse events (irAE) on metastatic melanoma survivors treated with ipilimumab (IPI).
Melanoma survivors were identified within two study populations ( = 104), at a single-center university hospital, and defined as patients who were disease-free for at least 2 years after initiating IPI. Data were collected using 4 patient-reported outcome measures, computerized NCF testing, and a semistructured interview at the start and 1-year follow-up.
Out of 18 eligible survivors, 17 were recruited (5F/12M); median age is 57 years (range 33-86); and median time since initiating IPI was 5.6 years (range 2.1-9.3). The clinical interview revealed that survivors suffered from cancer-related emotional distress such as fear of recurrence ( = 8), existential problems ( = 2), survivor guilt ( = 2), and posttraumatic stress disorder ( = 6). The mean EORTC QLQ-C30 Global Score was not significantly different from the European mean of the healthy population. Nine survivors reported anxiety and/or depression (Hospitalization Depression Scale) during the survey. Seven survivors (41%) reported fatigue (Fatigue Severity Scale). Seven patients (41%) had impairment in NCF; only three out of seven survivors had impairment in subjective cognition (Cognitive Failure Questionnaire). Anxiety, depression, fatigue, and neurocognitive symptoms remained stable at the 1-year follow-up. All cases of skin toxicity ( = 8), hepatitis ( = 1), colitis ( = 3), and sarcoidosis ( = 1) resolved without impact on HRQoL. Three survivors experienced hypophysitis; all suffered from persistent fatigue and cognitive complaints 5 years after onset. One survivor who experienced a Guillain-Barré-like syndrome suffered from persisting depression, fatigue, and impairment in NCF.
A majority of melanoma survivors treated with IPI continue to suffer from emotional distress and impairment in NCF. Timely detection in order to offer tailored care is imperative, with special attention for survivors with a history of neuroendocrine or neurological irAE. The trial is registered with B.U.N. 143201421920.
评估接受伊匹单抗（IPI）治疗的转移性黑色素瘤幸存者的神经认知功能（NCF）、心理社会结局、健康相关生活质量（HRQoL）和免疫相关不良事件（irAE）的长期影响。
在单中心大学医院的两个研究人群中确定黑色素瘤幸存者（=104 例），定义为在开始 IPI 后至少 2 年无疾病的患者。使用 4 种患者报告的结局测量工具、计算机化 NCF 测试和半结构化访谈，在开始时和 1 年随访时收集数据。
18 名符合条件的幸存者中有 17 名（5 名女性/12 名男性）被招募；中位年龄为 57 岁（范围 33-86 岁）；自开始 IPI 以来的中位时间为 5.6 年（范围 2.1-9.3 年）。临床访谈显示，幸存者患有与癌症相关的情绪困扰，如恐惧复发（=8）、存在问题（=2）、幸存者内疚（=2）和创伤后应激障碍（=6）。EORTC QLQ-C30 全球评分平均值与欧洲健康人群的平均值无显著差异。9 名幸存者（=9）在调查期间报告焦虑和/或抑郁（住院抑郁量表）。7 名幸存者（=7）报告疲劳（疲劳严重程度量表）。7 名患者（=7）存在 NCF 损伤；仅有 3 名幸存者存在主观认知损伤（认知失败问卷）。焦虑、抑郁、疲劳和神经认知症状在 1 年随访时保持稳定。所有皮肤毒性（=8）、肝炎（=1）、结肠炎（=3）和结节病（=1）均得到解决，对 HRQoL 无影响。3 名幸存者发生垂体炎；所有患者在发病 5 年后均持续出现疲劳和认知主诉。1 名发生格林-巴利样综合征的幸存者持续存在抑郁、疲劳和 NCF 损伤。
接受 IPI 治疗的黑色素瘤幸存者大多数仍患有情绪困扰和 NCF 损伤。及时发现以便提供定制护理至关重要，特别要注意有神经内分泌或神经 irAE 病史的幸存者。该试验在 B.U.N. 143201421920 上注册。
