PMID- 35944229
OWN - NLM
STAT- MEDLINE
DCOM- 20221013
LR  - 20221128
IS  - 2688-1535 (Electronic)
IS  - 2688-1527 (Linking)
VI  - 18
IP  - 10
DP  - 2022 Oct
TI  - End-of-Life Use of Systemic Therapy in Patients With Advanced Melanoma: A 
      Nationwide Cohort Study.
PG  - e1611-e1620
LID - 10.1200/OP.22.00061 [doi]
AB  - PURPOSE: The introduction of immune checkpoint inhibitors and targeted therapies 
      improved the overall survival of patients with advanced melanoma. It is not known 
      how often these costly treatments with potential serious side effects are 
      ineffectively applied in the last phase of life. This study aimed to investigate 
      the start of a new systemic therapy within 45 and 90 days of death in Dutch 
      patients with advanced melanoma. METHODS: We selected patients who were diagnosed 
      with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma 
      Treatment Registry, and died between 2013 and 2019. Primary outcome was the 
      probability of starting a new systemic therapy 45 and 90 days before death. 
      Secondary outcomes were type of systemic therapy started, grade 3/4 adverse 
      events (AEs), and the total costs of systemic therapies. RESULTS: Between 2013 
      and 2019, 3,797 patients with unresectable IIIC or stage IV melanoma were entered 
      in the registry and died. The percentage of patients receiving a new systemic 
      therapy within 45 and 90 days before death was significantly different between 
      Dutch melanoma centers (varying from 6% to 23% and 20% to 46%, respectively). 
      Thirteen percent of patients (n = 146) developed grade 3/4 AEs in the last period 
      before death. The majority of patients with an AE required hospital admission (n 
      = 102, 69.6%). Mean total costs of systemic therapy per cohort year of the 
      patients who received a new systemic therapy within 90 days before death were 
      2.3%-2.8% of the total costs spent on melanoma therapies. CONCLUSION: The 
      minority of Dutch patients with metastatic melanoma started a new systemic 
      therapy in the last phase of life. However, the percentages varied between Dutch 
      melanoma centers. Financial impact of these therapies in the last phase of life 
      is relatively small.
FAU - van Breeschoten, Jesper
AU  - van Breeschoten J
AUID- ORCID: 0000-0002-1334-2232
AD  - Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
AD  - Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, 
      Cancer Center Amsterdam, Amsterdam, the Netherlands.
FAU - Ismail, Rawa K
AU  - Ismail RK
AUID- ORCID: 0000-0002-0838-0349
AD  - Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
AD  - Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for 
      Pharmaceutical Sciences, Utrecht, the Netherlands.
FAU - Wouters, Michel W J M
AU  - Wouters MWJM
AUID- ORCID: 0000-0001-6173-0662
AD  - Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
AD  - Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands.
AD  - Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, 
      the Netherlands.
FAU - Hilarius, Doranne L
AU  - Hilarius DL
AD  - Department of Pharmacy, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands.
FAU - de Wreede, Liesbeth C
AU  - de Wreede LC
AD  - Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, 
      the Netherlands.
FAU - Haanen, John B
AU  - Haanen JB
AUID- ORCID: 0000-0001-5884-7704
AD  - Department of Medical Oncology and Immunology, Netherlands Cancer Institute, 
      Amsterdam, the Netherlands.
AD  - Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, 
      Amsterdam, the Netherlands.
AD  - Department of Medical Oncology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Blank, Christian U
AU  - Blank CU
AUID- ORCID: 0000-0002-7945-5846
AD  - Department of Medical Oncology and Immunology, Netherlands Cancer Institute, 
      Amsterdam, the Netherlands.
AD  - Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, 
      Amsterdam, the Netherlands.
FAU - Aarts, Maureen J B
AU  - Aarts MJB
AD  - Department of Medical Oncology, GROW School for Oncology and Developmental 
      Biology. Maastricht University Medical Center, Maastricht, the Netherlands.
FAU - van den Berkmortel, Franchette W P J
AU  - van den Berkmortel FWPJ
AD  - Department of Medical Oncology, Zuyderland Medical Center Sittard, 
      Sittard-Geleen, the Netherlands.
FAU - de Groot, Jan Willem B
AU  - de Groot JWB
AD  - Isala Oncology Center, Isala, Zwolle, the Netherlands.
FAU - Hospers, Geke A P
AU  - Hospers GAP
AD  - Department of Medical Oncology, University Medical Center Groningen, University 
      of Groningen, Groningen, the Netherlands.
FAU - Kapiteijn, Ellen
AU  - Kapiteijn E
AD  - Department of Medical Oncology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Piersma, Djura
AU  - Piersma D
AD  - Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the 
      Netherlands.
FAU - van Rijn, Rozemarijn S
AU  - van Rijn RS
AD  - Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the 
      Netherlands.
FAU - Stevense-den Boer, Marion A
AU  - Stevense-den Boer MA
AUID- ORCID: 0000-0001-5998-8066
AD  - Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands.
FAU - van der Veldt, Astrid A M
AU  - van der Veldt AAM
AD  - Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the 
      Netherlands.
FAU - Vreugdenhil, Gerard
AU  - Vreugdenhil G
AD  - Department of Internal Medicine, Maxima Medical Center, Eindhoven, the 
      Netherlands.
FAU - Boers-Sonderen, Marye J
AU  - Boers-Sonderen MJ
AD  - Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the 
      Netherlands.
FAU - Suijkerbuijk, Karijn P M
AU  - Suijkerbuijk KPM
AD  - Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the 
      Netherlands.
FAU - van den Eertwegh, Alfons J M
AU  - van den Eertwegh AJM
AD  - Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, 
      Cancer Center Amsterdam, Amsterdam, the Netherlands.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220809
PL  - United States
TA  - JCO Oncol Pract
JT  - JCO oncology practice
JID - 101758685
RN  - 0 (Immune Checkpoint Inhibitors)
SB  - IM
MH  - Cohort Studies
MH  - Death
MH  - Humans
MH  - *Immune Checkpoint Inhibitors
MH  - Immunotherapy
MH  - *Melanoma/drug therapy/pathology/secondary
COIS- Rawa K. IsmailEmployment: MSD John B. HaanenStock and Other Ownership Interests: 
      Neogene TherapeuticsConsulting or Advisory Role: MSD Oncology (Inst), Pfizer 
      (Inst), Bristol Myers Squibb (Inst), Novartis (Inst), Roche/Genentech (Inst), 
      Ipsen (Inst), Achilles Therapeutics (Inst), Immunocore (Inst), Sanofi (Inst), 
      Third Rock Ventures (Inst), Neogene Therapeutics, Molecular Partners (Inst), 
      bioNTech (Inst), T-Knife (Inst), PokeAcell (Inst), Instil Bio (Inst), Iovance 
      Biotherapeutics (Inst)Research Funding: MSD (Inst), Bristol Myers Squibb (Inst), 
      Novartis (Inst), Neon Therapeutics (Inst), Amgen (Inst), BioNTech (Inst), Asher 
      Biotherapeutics (Inst) Christian U. BlankStock and Other Ownership Interests: 
      ImmageneConsulting or Advisory Role: Roche/Genentech (Inst), MSD Oncology (Inst), 
      Bristol Myers Squibb (Inst), Novartis (Inst), GlaxoSmithKline (Inst), Pfizer 
      (Inst), AstraZeneca (Inst), Lilly (Inst), Pierre Fabre (Inst), GenMab (Inst), 
      Third Rock VenturesResearch Funding: Bristol Myers Squibb (Inst), Novartis 
      (Inst), NanoString Technologies (Inst), 4SC (Inst)Patents, Royalties, Other 
      Intellectual Property: WO 2021/177822 A1Expert Testimony: FreshfieldsTravel, 
      Accommodations, Expenses: Bristol Myers Squibb Maureen J.B. AartsResearch 
      Funding: Pfizer (Inst) Jan Willem B. de GrootConsulting or Advisory Role: Bristol 
      Myers Squibb, Pierre Fabre, Servier Geke A.P. HospersConsulting or Advisory Role: 
      Roche (Inst), MSD (Inst), Amgen (Inst), Bristol Myers Squibb (Inst), Novartis 
      (Inst), Pierre Fabre (Inst), Sanofi (Inst)Research Funding: Bristol Myers Squibb 
      (Inst), Seerave Foundation (Inst) Ellen KapiteijnConsulting or Advisory Role: 
      Pierre Fabre (Inst), Bristol Myers Squibb (Inst), Novartis (Inst), Lilly (Inst), 
      Ipsen (Inst), Delcath Systems (Inst)Research Funding: BMS (Inst), Pierre Fabre 
      (Inst) Djura PiersmaConsulting or Advisory Role: Pierre Fabre (Inst), Novartis 
      (Inst) Astrid A.M. van der VeldtConsulting or Advisory Role: Ipsen (Inst), Roche 
      (Inst), Bristol Myers Squibb (Inst), Pfizer (Inst), MSD Oncology (Inst), Sanofi 
      (Inst), Pierre Fabre (Inst), Novartis (Inst), Eisai (Inst), Merck (Inst)Research 
      Funding: Bayer (Inst)Travel, Accommodations, Expenses: Roche, MSD Oncology, 
      Novartis, Bayer Karijn P.M. SuijkerbuijkConsulting or Advisory Role: Bristol 
      Myers Squibb (Inst), Novartis (Inst), MSD (Inst), Pierre Fabre (Inst), AbbVie 
      (Inst)Speakers' Bureau: Roche (Inst), Novartis (Inst)Research Funding: Bristol 
      Myers Squibb Foundation (Inst), TigaTx (Inst), Philips Research (Inst) Alfonsus 
      J.M. van den EertweghHonoraria: Bristol Myers SquibbConsulting or Advisory Role: 
      Bristol Myers Squibb, MSD Oncology, Amgen, Roche, Novartis, Sanofi, Pfizer, 
      Ipsen, Merck, Pierre FabreResearch Funding: Roche, Sanofi, BMSNo other potential 
      conflicts of interest were reported.
EDAT- 2022/08/10 06:00
MHDA- 2022/10/14 06:00
CRDT- 2022/08/09 16:03
PHST- 2022/08/10 06:00 [pubmed]
PHST- 2022/10/14 06:00 [medline]
PHST- 2022/08/09 16:03 [entrez]
AID - 10.1200/OP.22.00061 [doi]
PST - ppublish
SO  - JCO Oncol Pract. 2022 Oct;18(10):e1611-e1620. doi: 10.1200/OP.22.00061. Epub 2022 
      Aug 9.