Patients with advanced melanoma evaluated their treatment positively, with immune checkpoint inhibition (ICI) apparently preferred over targeted therapy (TT) in the adjuvant setting, according to the results of a patient-oriented, cross-sectional, comparative, multicenter study published in the Journal of the European Academy of Dermatology and Venereology.
Researchers sought to assess the impact of disease and treatment on the daily lives of patients who were receiving systemic therapy for melanoma. The current study was conducted at 13 specialized skin cancer centers in Germany from August 2020 through March 2021.
Patients 18 years of age and older who were receiving systemic treatment for melanoma were asked to anonymously complete a self-administered 5-page questionnaire. All patients were questioned about their perception of their disease and its symptoms; the impact of their current treatment on quality of life (QOL), work, daily activities, and hobbies; treatment-related adverse events (AEs); therapeutic visits and the intervals in between, along with satisfaction with and belief in their current treatment and a comparison with prior therapies. Patient-reported outcome (PROs) were rated on a continuous numerical rating scale, which ranged from 0 to 10, or were chosen from a list that was provided.
A total of 414 patients who provided information about their treatment were included in the analysis — 359 of whom were treated with ICI and 55 of whom received TT. Information on their specific treatment was provided by 314 patients receiving ICI and 54 individuals receiving TT. More participants treated with ICI (63.1%) or TT (68.5%) received their therapy in the unresectable/metastatic setting, as opposed to receiving adjuvant treatment.
Although the treatment groups did not differ significantly with respect to treatment setting, gender, age, partnership status, employment status, educational level, social responsibilities, frequency of physical training, or presence of comorbidities, in the unresectable/metastatic setting, patients in the TT group received their treatment more frequently in a later line of therapy.
Per subgroup analysis, in the adjuvant setting only, patients in the TT arm reported a significant reduction in their treatment-associated QOL compared with those in the ICI arm (P =.02). Further, patients treated with TT were 1.9 times more likely than those treated with ICI to report AEs — a difference that was, to researchers, significant in the adjuvant setting (P =.01).
ICI treatment intervals differed significantly between the adjuvant setting and the unresectable/metastatic setting (P =.04), although all patients, regardless of the specific ICI agent with which they were being treated, assessed their treatment frequency as adequate. Patients in the TT group treated with dabrafenib/trametinib (n=37) or encorafenib/binimetinib (n=15) did not differ with respect to the strain associated with their daily pill intake. Participants older than 63 years of age rated various PROs higher than did younger patients.
Several limitations of the current analysis warrant mention. Because it was designed as a cross-sectional study, no follow-up data were provided. Further, the moment of participation during the individual course of treatment and the efficacy data were not taken into account, researchers noted. In addition, since the questionnaires were completed by the patients themselves, their responses were not verified with the information in their medical records.
Study authors concluded that “ICI might be preferred over TT regarding QOL and patient-reported AEs in the adjuvant setting. Older [patients with melanoma] appeared to be less impacted by their disease and more satisfied with their treatment.”
Disclosure: Several of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Thiem A, Mashhadiakbar P, Cussigh C, et al. Immune checkpoint inhibition and targeted therapy for melanoma: a patient-oriented cross-sectional comparative multicentre study. J Eur Acad Dermatol Venereol. Published online November 25, 2022. doi:10.1111/jdv.18778