Preferences of physicians for treatment-related toxicity vs. recurrence in melanoma (GERMELATOX-A): the doctors' perspective.

Autor: Kähler KC; Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany. kckaehler@yahoo.de., Gutzmer R; Department of Dermatology, Johannes Wesling Medical Center Minden, Ruhr University Bochum Medical School, Bochum, Germany., Angela Y; Department of Dermatology, Johannes Wesling Medical Center Minden, Ruhr University Bochum Medical School, Bochum, Germany., Livingstone E; Department of Dermatology, University Hospital Essen, Essen, Germany., Lodde G; Department of Dermatology, University Hospital Essen, Essen, Germany., Meiss F; Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany., Rafei-Shamsabadi DA; Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany., Weyer-Fahlbusch SS; Department of Dermatology, Dortmund, Germany., Nashan D; Department of Dermatology, Dortmund, Germany., Loquai C; Department of Dermatology, Klinikum Bremen-Ost, Gesundheitnord gGmbH, Bremen, Germany., Hassel JC; Medical Faculty Heidelberg, Department of Dermatology and National Center for Tumor Diseases (NCT), Heidelberg University, NCT Heidelberg, a partnership between DKFZ and University Hospital Heidelberg, Heidelberg, Germany., Sachse MMM; Department of Dermatology, Bremerhaven, Germany., Maul LV; Department of Dermatology, University Hospital Basel, Basel, Switzerland.; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland., Heinzerling L; Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany., Heppt MV; Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany., Colapietro C; Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany., Rusch J; Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Blome C; Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Jazyk: angličtina
Zdroj: Journal of cancer research and clinical oncology [J Cancer Res Clin Oncol] 2024 May 14; Vol. 150 (5), pp. 252. Date of Electronic Publication: 2024 May 14.
DOI: 10.1007/s00432-024-05713-6
Abstrakt: Introduction: Adjuvant treatment with immune checkpoint inhibitors, such as PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT), has shown a significant improvement in disease-free survival (DFS) for high-risk melanoma patients. However, due to specific side effects, the choice of treatment is often influenced by the risk of toxicity. Therefore, the role of physicians in treatment decisions of patients is crucial. This study investigated for the first time in a multicenter setting the attitudes and preferences of dermatooncologists in Germany and Switzerland regarding adjuvant treatment with (c)ICI and TT.
Methods: In the GERMELATOX-A study, 108 physicians (median age: 32 yrs, 67.6% female) from 11 skin cancer centers were surveyed to rate typical side effect scenarios of (c)ICI and TT treatments and then compared to patients' ratings evaluated in a previous analysis from the same centers. The scenarios described mild-to-moderate or severe toxicity and included melanoma relapse leading to death. The physicians were asked about the level of side effects they would tolerate in exchange for a reduction in melanoma relapse and an increase in survival at 5 years.
Results: The preferences of physicians and patients revealed significant differences regarding adjuvant melanoma treatment with (c)ICI and TT (p < 0.05). Compared to patients, physicians tend to value a melanoma relapse less severe, according to a visual analog scale. They were also less threatened by all scenarios of side effects during adjuvant treatment with (c)ICI or TT, compared to patients. Physicians required lower risk reductions for disease-free survival (DFS) and overall survival (OS) for both ICI and TT and their drug-related side effects to accept these treatments. In case of severe side effects, physicians required similar 5-year DFS rates for ICI and TT (60-65%), while patients needed a 15% improvement of 5-year DFS for ICI compared to TT (80%/65%). For survival, physicians expected an OS improvement of + 10% for all three treatment modalities, whereas patients required a higher increase: + 18-22% for ICI and + 15% for TT.
Conclusion: Our study highlights the importance of understanding the patient's perspective and a potential difference to the doctor's view when making decisions about adjuvant melanoma treatment with (c)ICI and TT, especially as these treatments are increasingly being implemented in earlier stages.
(© 2024. The Author(s).)
Databáze: MEDLINE
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