TY - JOUR
T1 - Treatment at the end of life in patients with advanced melanoma. A multicenter DeCOG study of 1067 patients from the prospective skin cancer registry ADOReg
AU - Forschner, Andrea
AU - Kähler, Katharina C.
AU - Gschnell, Martin
AU - Langan, Ewan A.
AU - Weishaupt, Carsten
AU - Meiss, Frank
AU - Thoms, Kai Martin
AU - Wahl, Renate U.
AU - Göppner, Daniela
AU - Garzarolli, Marlene
AU - Sachse, Michael
AU - Schlaak, Max
AU - Reitmajer, Markus
AU - Kellner, Ivonne
AU - Gesierich, Anja
AU - Mohr, Peter
AU - Meier, Friedegund
AU - von Wasielewski, Imke
AU - Herbst, Rudolf
AU - Utikal, Jochen
AU - Pföhler, Claudia
AU - Ulrich, Jens
AU - Terheyden, Patrick
AU - Kaatz, Martin
AU - Haferkamp, Sebastian
AU - Leiter, Ulrike
AU - Ugurel, Selma
AU - Weichenthal, Michael
AU - Berking, Carola
AU - Gutzmer, Ralf
AU - Schadendorf, Dirk
AU - Nanz, Lena
AU - Loquai, Carmen
N1 - Publisher Copyright:
Copyright © 2025 Forschner, Kähler, Gschnell, Langan, Weishaupt, Meiss, Thoms, Wahl, Göppner, Garzarolli, Sachse, Schlaak, Reitmajer, Kellner, Gesierich, Mohr, Meier, von Wasielewski, Herbst, Utikal, Pföhler, Ulrich, Terheyden, Kaatz, Haferkamp, Leiter, Ugurel, Weichenthal, Berking, Gutzmer, Schadendorf, Nanz and Loquai.
PY - 2025
Y1 - 2025
N2 - Background: Although systemic therapies have improved considerably over the last decade, up to 50% of patients with metastatic melanoma still die due to disease progression. Oncological treatment at the end-of-life phase is challenging. The aim of this study was to investigate the frequency and type of systemic therapy received by melanoma patients in their end-of-life phase. Methods: Patients with metastatic melanoma who had died between January 1, 2018 and October 31, 2022 were identified from the prospective multicenter skin cancer registry ADOReg. Study endpoints were percentage of patients who had been treated with systemic therapy within the last three months of life, timepoint of initiation of the last-line therapy, overall survival, treatment benefit and the incidence of treatment-related adverse events. Results: In total, 1067 patients from 46 skin cancer centers were included. Most of the patients (63%) had received immune checkpoint inhibitors (ICI) as last-line therapy, 22% targeted therapies (TT) and 12% chemotherapy (CTX). Comparing last-line ICI and TT, patients with TT were significantly more likely to benefit from treatment and had significantly fewer and milder treatment-related AE than patients with ICI. Even though two thirds of patients had received ICI as a last-line therapy, the majority of these patients (61%) had stopped therapy within the last 30 days of life, whereas the majority of patients with TT (66%) still continued their treatment to the end of life. We found markedly fewer patients with initiation of ICI within 30 days before their death (19%) compared to a historic cohort including patients who died in 2016 or 2017 (39%). Conclusion: Treatment approaches near the end of life have markedly changed in skin cancer centers in Germany over recent years, with ICI prescribed less frequently in the end-of-life phase. In contrast, TT are frequently administered, even within the last 30 days of life. It should also be considered that discontinuation of TT can result in rapid tumor progression. Due to the oral administration and a low rate of severe toxicity, TT appear to be a suitable treatment option, even in the end-of-life situation of melanoma patients.
AB - Background: Although systemic therapies have improved considerably over the last decade, up to 50% of patients with metastatic melanoma still die due to disease progression. Oncological treatment at the end-of-life phase is challenging. The aim of this study was to investigate the frequency and type of systemic therapy received by melanoma patients in their end-of-life phase. Methods: Patients with metastatic melanoma who had died between January 1, 2018 and October 31, 2022 were identified from the prospective multicenter skin cancer registry ADOReg. Study endpoints were percentage of patients who had been treated with systemic therapy within the last three months of life, timepoint of initiation of the last-line therapy, overall survival, treatment benefit and the incidence of treatment-related adverse events. Results: In total, 1067 patients from 46 skin cancer centers were included. Most of the patients (63%) had received immune checkpoint inhibitors (ICI) as last-line therapy, 22% targeted therapies (TT) and 12% chemotherapy (CTX). Comparing last-line ICI and TT, patients with TT were significantly more likely to benefit from treatment and had significantly fewer and milder treatment-related AE than patients with ICI. Even though two thirds of patients had received ICI as a last-line therapy, the majority of these patients (61%) had stopped therapy within the last 30 days of life, whereas the majority of patients with TT (66%) still continued their treatment to the end of life. We found markedly fewer patients with initiation of ICI within 30 days before their death (19%) compared to a historic cohort including patients who died in 2016 or 2017 (39%). Conclusion: Treatment approaches near the end of life have markedly changed in skin cancer centers in Germany over recent years, with ICI prescribed less frequently in the end-of-life phase. In contrast, TT are frequently administered, even within the last 30 days of life. It should also be considered that discontinuation of TT can result in rapid tumor progression. Due to the oral administration and a low rate of severe toxicity, TT appear to be a suitable treatment option, even in the end-of-life situation of melanoma patients.
UR - http://www.scopus.com/inward/record.url?scp=86000606721&partnerID=8YFLogxK
U2 - 10.3389/fimmu.2025.1509886
DO - 10.3389/fimmu.2025.1509886
M3 - Journal articles
C2 - 40066437
AN - SCOPUS:86000606721
SN - 1664-3224
VL - 16
JO - Frontiers in Immunology
JF - Frontiers in Immunology
M1 - 1509886
ER -
