the survivorship experience for patients with metastatic melanoma on immune checkpoint and braf-mek inhibitors

Immune checkpoint inhibitors (ici) and braf and mek inhibitors (bmi) have improved survival in metastatic melanoma (mm). however, the experience of long-term responders remains undescribed. this study characterised survivorship issues faced by long-term responders to ici or bmi. patients with mm, aged ≥ 18 years old, ≥ 6 months post-ici or bmi initiation with an objective response or stable disease. a 72-question survey assessed physical and psychological effects, impact on lifestyle, access to information, satisfaction with care, and availability of supports. one hundred and five of 120 (88%) patients completed the survey (ici 69/bmi 36). for the ici cohort, 39 (57%) were receiving ongoing treatment, 17 ceased due to toxicity and 13 due to a sustained response. for the bmi cohort, 31 (85%) were receiving ongoing treatment, 4 ceased due to toxicity and 1 due to a sustained complete response. at data cut-off on 18 2018, median pfs (range) was 2.5 years (1.3–8.5) for ici and 3.1 years (0.6–7.3) for bmi. long-term toxicities included dry/itchy skin (ici 51, 74%/ bmi 25, 69%), arthralgias (ici 30, 58%/ bmi 23, 64%) and fatigue (ici 62, 90%/ bmi 33, 92%). psychological morbidity was common, including anxiety awaiting results (ici 50, 72%/ bmi 29, 81%), fear of melanoma recurring or progressing (ici 56, 81%/ bmi 31, 86%) or death (ici 44, 64%/ bmi 26, 72%). mm survivors experience chronic treatment toxicities and frequently report psychological concerns. survivors benefit from discussions regarding long-term toxicities and tailored psychological supports.