Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Cancer Med. 2023 Jun;12(11):12861-12873. doi: 10.1002/cam4.5967. Epub 2023 Apr 29.
Immune checkpoint inhibitors (ICIs) have significantly improved survival in advanced melanoma but are associated with immune-related adverse events (irAEs). This single center, cross-sectional survey aimed to describe the long-term symptom burden and impact on health-related quality of life (HRQL) of advanced melanoma patients with sustained disease control following treatment with ICIs.
Advanced melanoma patients (stage IIB, III or IV, AJCCv8), treated with anti-PD1-based ICIs, who were off-treatment and had at least 6 months follow-up from their last infusion with an ongoing response in the metastatic setting or no evidence of disease recurrence in the adjuvant setting. A paper-based questionnaire, consisting of the EORTC QLQ-C30, EORTC QLQ-FA12, and the PRO-CTCAE was administered.
Of 90 participants, 61 (68%) completed the questionnaire; 40 received single-agent anti-PD1, and 21 anti-PD1/anti-CTLA4. Thirty-three (54%) were treated in the adjuvant setting. At the time of enrolment, 31 (51%) participants had active treatment for a previous irAE. Overall, 18/61 (30%) participants reported long-term symptoms and trouble in physical and emotional functioning. Physical fatigue was common and interfered with daily activities (n = 12, 20%). In the PRO-CTCAE questionnaire, muscle ache (n = 12, 20%) and joint ache (n = 9, 15%) were commonly reported. Despite this, participants reported overall good health (6.00, range 2.00-7.00) and reasonable level of HRQL (6.00, range 3.00-7.00).
Melanoma survivors experience long-term symptoms in physical and psychosocial HRQL domains after ICI treatment. These results underline the importance to address existing gaps in survivorship care, implement these findings in clinical practice and increase awareness for long-term symptoms in these patients.
免疫检查点抑制剂（ICIs）显著提高了晚期黑色素瘤患者的生存率，但与免疫相关不良事件（irAEs）有关。本单中心横断面研究旨在描述接受抗 PD-1 为基础的 ICI 治疗后疾病持续控制的晚期黑色素瘤患者的长期症状负担和对健康相关生活质量（HRQL）的影响。
接受抗 PD-1 为基础的 ICI 治疗的晚期黑色素瘤患者（AJCCv8 分期 IIB、III 或 IV 期），在转移性疾病中持续缓解或辅助治疗中无疾病复发的情况下停药且最后一次输注后至少有 6 个月的随访。使用纸质问卷，包括 EORTC QLQ-C30、EORTC QLQ-FA12 和 PRO-CTCAE 进行评估。
在 90 名参与者中，有 61 名（68%）完成了问卷；40 名接受单药抗 PD-1，21 名接受抗 PD-1/抗 CTLA4。33 名（54%）在辅助治疗中。在入组时，31 名（51%）参与者因先前的 irAE 正在接受治疗。总体而言，61 名参与者中有 18 名（30%）报告存在长期症状和身体及情绪功能障碍。身体疲劳很常见，会干扰日常活动（n=12，20%）。在 PRO-CTCAE 问卷中，肌肉疼痛（n=12，20%）和关节疼痛（n=9，15%）也经常报告。尽管如此，参与者报告总体健康状况良好（6.00，范围 2.00-7.00）和合理的 HRQL 水平（6.00，范围 3.00-7.00）。
黑色素瘤幸存者在接受 ICI 治疗后，在身体和心理社会 HRQL 领域经历长期症状。这些结果强调了在生存护理中解决现有差距的重要性，将这些发现付诸临床实践，并提高对这些患者长期症状的认识。
