Characteristics and quality of life of nine-year survivors from 312 patients with metastatic melanoma treated with pembrolizumab

BackgroundImmune checkpoint blockers (ICB) have improved overall survival of metastatic melanoma patients. Therefore, quality of life and long-term sequelae from ICB induced immune-related adverse events (irAE) are of importance.Methods13 German skin cancer centers evaluated survival of melanoma patients that started pembrolizumab before 07/2015 after progression with at that time standard of care agents (ipilimumab, BRAF/MEK inhibition, chemotherapy). The number of melanoma survivors, deaths and patients lost to follow-up was assessed. For surviving patients baseline characteristics, efficacy and irAE under therapy were collected. Patients were interviewed about current symptoms and quality of life.ResultsFrom 312 treated patients 231 (74%) have died, 28 (9%) were lost to follow-up and 53 (17%) are still alive after a median follow-up of 9.1 years from treatment start. In this surviving cohort (n=53), baseline characteristics were: 31 (58%) male, median age 60 (range 27-76), 35 (66%) ECOG 0, 21 (40%) BRAFV600E/K mutated, 35 (66%) M1c/d stage, 23 (43%) with elevated LDH and a median number of 2 pretreatments (range 1-6). Survivors showed an overall response rate of 91% with 37 complete responses (CR, 70%). 21 (40%) patients eventually progressed with subsequent treatments being mainly ICB (18) and local therapies (10). As of January 2024, 45 (85%) patients are without evidence of disease and 6 (11%) with controlled disease. Concerning toxicity, 38 (72%) experienced irAE under therapy, 15 (28%) of grade 3/4. After now almost 10 years, 18 (34%) patients state persisting symptoms, mainly vitiligo (4), hypothyroidism (4), pituitary/adrenal gland insufficiency (3) and fatigue (3). Of 23 patients still in working age, 8 (35%) were not able to work anymore. However, quality of life as measured by median WHO-5 score was 19 (76%) which is above the mean scores for the general population in Germany.ConclusionsPembrolizumab induced long-term survival in 17% of patients with pretreated metastatic melanoma in a real-world setting, most of them responded to pembrolizumab with a CR. Permanent sequela from immunotherapy were noted, however, quality of life was good in most patients.Legal entity responsible for the studyJ. Hassel.FundingHas not received any funding.DisclosureJ.C. Hassel: Financial Interests, Personal, Invited Speaker: BMS, Novartis, Sanofi, MSD, SunPharma, Amgen, GSK, Pierre Fabre, Immunocore, Delcath; Financial Interests, Institutional, Advisory Board: MSD, Novartis, BMS, Immunocore, Philogen, Sanofi; Financial Interests, Personal, Advisory Board: Pierre Fabre, SunPharma, GSK, Onkowissen, Pierre Fabre; Financial Interests, Institutional, Writing Engagement: BMS; Financial Interests, Institutional, Research Grant: BMS, SunPharma, Sanofi; Financial Interests, Institutional, Local PI: Philogen, Genentech, 4SC, BioNTech, Iovance, Pierre Fabre, Regeneron, Sanofi, Replimune, Immatics, MSD, Pfizer, Agenus; Financial Interests, Institutional, Coordinating PI: BMS, Immunocore, Novartis, Genmab, Seagan; Financial Interests, Personal, Steering Committee Member: Immunocore, IO Biotech; Non-Financial Interests, Leadership Role: DeCOG; Non-Financial Interests, Member: ASCO. A. Forschner: Financial Interests, Institutional, Advisory Board: Novartis, MSD, BMS, Pierre Fabre, Immunocore; Financial Interests, Institutional, Invited Speaker: Immunocore, Novarits, BMS, Pierre Fabre; Financial Interests, Institutional, Research Grant: BMS Immunoncology; Non-Financial Interests, Member: ADO, DKG, PSO, DDG; Non-Financial Interests, Leadership Role: ADO Komitee Survivorship; Other, Other, congress participation including travel and hotel: Pierre Fabre. M. Erdmann: Financial Interests, Personal, Advisory Board, Clinical case presentation: Immunocore; Financial Interests, Personal, Invited Speaker, Presentation at workshop for nurses: Novartis; Financial Interests, Personal, Invited Speaker, Presentation at workshop as well as travel/meeting expenses: Pierre Fabre; Financial Interests, Personal, Other, travel expenses: Sanofi. R. Gutzmer: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Pierre Fabre, Novartis, MSD, Merck Serono, Almirall, Immunocore, Delcath, KyowaKirin, Sanofi/Regeneron, SUN Pharma; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb, Pierre Fabre, Novartis, MSD, Merck Serono, Almirall, Sanofi/Regeneron, SUN Pharma; Financial Interests, Institutional, Research Grant: KyowaKirin, Almirall, SUN Pharma, Amgen, Sanofi/Regeneron, Merck Serono; Non-Financial Interests, Member of Board of Directors: DeCOG; Other, Other, Travel and meeting support: Pierre Fabre, SUN Pharma. K.C. Kähler: Financial Interests, Advisory Board: BMS, MSD, Pierre Fabre, Roche, Immunocore, Regeneron, Sanofi-Aventis, Delcath; Financial Interests, Research Funding: MSD, Immunocore, Huya-Biosciences, BMS, Roche, Sanofi-Aventis, Pierre Fabre. H. Stege: Financial Interests, Invited Speaker: BMS, MSD, SunPharma, Pierre Fabre. C. Franklin: Financial Interests, Personal, Advisory Board: BMS, Pierre Fabre, Novartis. A. Sindrilaru: Financial Interests, Personal, Advisory Board, consulting: MSD, BMS, Pierre Fabre, Novartis; Financial Interests, Personal, Invited Speaker, Speaker fee at regional conferences: Sanofi / Regeneron; Financial Interests, Personal, Invited Speaker, speaker fee, travel expenses: Immunocore; Financial Interests, Personal, Advisory Board, consulting and speaker fee: SunPharma; Financial Interests, Personal, Invited Speaker, speaker fee at regional conferences: Kyowa Kirin, Takeda; Non-Financial Interests, Principal Investigator, clinical trial: MSD, BMS, Huyabio, Regeneron, Pierre Fabre. L. Zimmer: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Novartis, MSD, SunPharma, Pierre Fabre, Sanofi; Financial Interests, Personal, Other, Travel Support: Bristol Myers Squibb, MSD, SunPharma, Pierre Fabre, Sanofi, Novartis, Amgen; Financial Interests, Personal, Invited Speaker: Novartis, MSD, Pierre Fabre, Roche; Financial Interests, Personal and Institutional, Research Grant: Novartis; Non-Financial Interests, Member: German Cancer Society, Dermatologic Cooperative Oncology Group. L. Heinzerling: Financial Interests, Personal, Advisory Board: Amgen, BiomeDx BMS, CureVac AG, Kyowa Kirin, MSD, Novartis, Roche, Sanofi, SunPharma, Therakos; Financial Interests, Institutional, Research Funding: Agenus, AstraZeneca, BioMedX, BMS, EORTC, Roche, Genentech, Huya Bioscience, Immunocore, IOBiotech, Merck, MSD, Miltenyi, Novartis, Pfizer, Pierre Fabre, Regeneron, Replimune, Sanofi-Aventis. J. Utikal: Financial Interests, Personal, Advisory Board: Amgen, Bristol Myers Squibb, Immunocore, Merck Sharp and Dohme, Novartis, Pierre Fabre, Rheacell, Sanofi. F. Meier: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Novartis, MSD, Sanofi, Philogen, Immunocore; Financial Interests, Personal, Invited Speaker: Sanofi, Immunocore. C. Berking: Financial Interests, Personal, Advisory Board: BMS, MSD, InflaRx, Sanofi, Regeneron, Novartis, Pierre Fabre, Delcath, Immunocore; Financial Interests, Personal, Invited Speaker: BMS, Almirall, MSD, Immunocore, Pierre Fabre, Leo Pharma; Financial Interests, Institutional, Coordinating PI: Almirall; Financial Interests, Institutional, Local PI: InflaRx, Immunocore, IOBiotech, Kartos, MSD, Regeneron. C. Garbe: Financial Interests, Personal, Advisory Board: CeCaVa, MSD, NeraCare, Philogen; Non-Financial Interests, Leadership Role, President: European Association of Dermatooncology (EADO). M. Weichenthal: Financial Interests, Personal, Advisory Board: MSD, Bristol Myers and Squibb, Sun Pharma, Sanofi, Pierre Fabre; Financial Interests, Institutional, Local PI: Millennium, Merck Sharp & Dohme, 4SC, Innate Pharma; Financial Interests, Institutional, Research Grant: Bristol Myers and Squibb, Novartis; Non-Financial Interests, Leadership Role: EUMelaReg; Non-Financial Interests, Member of Board of Directors: DeCOG. D. Schadendorf: Financial Interests, Personal, Invited Speaker: BMS, MSD, Merck Serono, Sanofi, Neracare, SunPharma; Financial Interests, Personal, Advisory Board: BMS, Novartis, MSD, Immunocore, Pierre Fabre, Sanofi/Regeneron, Pfizer, Philogen, Neracare, InFlarX, BioAlta, Daiichi Sanyko, NoviGenix, Anaveon, AstraZeneca, PamGene, BioNTech, Immatics, CureVac, Erasca, Formycon, Replimune, Seagen, SunPharma, Ultimovacs; Financial Interests, Personal, Steering Committee Member: Novartis, BMS, MSD; Financial Interests, Institutional, Coordinating PI: Novartis, BMS, MSD, Pierre Fabre; Financial Interests, Institutional, Research Grant: BMS, MSD; Financial Interests, Institutional, Local PI: Sanofi, Philogen; Non-Financial Interests, Member of Board of Directors: EORTC-MG; Non-Financial Interests, Leadership Role, Founding member and SC chair: European Melanoma Registry (EuMelaReg). A. Hauschild: Financial Interests, Personal, Advisory Board: BMS, MSD, Philogen, Pierre Fabre, Regeneron, Roche, Sanofi, Novartis, Eisai, Immunocore, Replimune, Seagen, Dermagnostix, Neracare, IO Biotech, Incyte, Highlight Therapeutics, Agenus, Xenthera; Financial Interests, Personal, Invited Speaker: Merck Pfizer; Financial Interests, Institutional, Local PI: BMS, MSD, Pierre Fabre, Amgen, Roche, Agenus; Financial Interests, Institutional, Coordinating PI: Regeneron, Novartis. P. Mohr: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Merck Sharp & Dohme, Merck Sharp & Dohme, Novartis, GSK, Pierre Fabre, Sanofi; Financial Interests, Personal, Invited Speaker: Amgen, Bristol Myers Squibb, Merck Sharp & Dohme, Merck Sharp & Dohme, Novartis, Roche, Pierre Fabre, Sanofi, Sun Pharma; Financial Interests, Institutional, Funding: Bristol Myers Squibb, Merck Sharp & Dohme, Novartis; Non-Financial Interests, Principal Investigator: Bristol Myers Squibb, Merck Sharp & Dohme, Regeneron, Sanofi, Novartis, Sun Pharma. All other authors have declared no conflicts of interest.