Abstract
Purpose
Ipilimumab was the first FDA-approved agent for advanced melanoma to improve survival and represents a paradigm shift in melanoma and cancer treatment. Its unique toxicity profile and kinetics of treatment response raise novel patient education challenges. We assessed patient perceptions of ipilimumab therapy across the treatment trajectory.
Methods
Four patient cohorts were assessed at different time points relative to treatment initiation: (1) prior to initiation of ipilimumab (n = 10), (2) at weeks 10–12 before restaging studies (n = 11), (3) at week 12 following restaging studies indicating progression of disease (n = 10), and (4) at week 12 following restaging studies indicating either a radiographic response or disease stability (n = 10). Patients participated in a semistructured qualitative interview to assess their experiences with ipilimumab. Quality of life was assessed via the Functional Assessment of Cancer Therapy-General and its Melanoma-specific module.
Results
Perceived quality of life was comparable across cohorts, and a majority of the sample understood side effects from ipilimumab and the potential for a delayed treatment response. Patients without progression of disease following restaging studies at week 12 held more positive views regarding ipilimumab compared to patients who had progressed.
Conclusion
Patients generally regarded ipilimumab positively despite the risk of unique toxicities and potential for delayed therapeutic responses; however, those with progression expressed uncertainty regarding whether taking ipilimumab was worthwhile. Physician communication practices and patient education regarding realistic expectations for therapeutic benefit as well as unique toxicities associated with ipilimumab should be developed so that patients can better understand the possible outcomes from treatment.
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Acknowledgements
We acknowledge the significant contribution of Dr. Thomas Atkinson who assisted with quantitative data analysis. Preliminary findings from interviews conducted with participants in the two week 12 sample cohorts highlighted in this paper were previously presented at the Tenth Anniversary International Congress of The Society for Melanoma Research. This work was supported by Bristol-Myers Squibb [RFP-US-11-CA184-010] initially awarded to Dr. Jason Luke, and subsequently held by Drs. Richard D. Carvajal and Jennifer L. Hay, and also by the Melanoma Disease Management team at Memorial Sloan Kettering Cancer Center. This project was additionally supported by a National Institutes of Health Support Grant [P30 CA08748-48], which provides partial support for the Behavioral Research Methods Core Facility in the Department of Psychiatry & Behavioral Sciences at Memorial Sloan Kettering Cancer Center, which was used in conducting this investigation.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of interest
This work was supported by Bristol-Myers Squibb [RFP-US-11-CA184-010] initially awarded to Dr. Jason Luke and subsequently held by Drs. Richard D. Carvajal and Jennifer L. Hay and also by the Melanoma Disease Management team at Memorial Sloan Kettering Cancer Center. This project was additionally supported by a National Institutes of Health Support Grant [P30 CA08748-48], which provides partial support for the Behavioral Research Methods Core Facility in the Department of Psychiatry & Behavioral Sciences at Memorial Sloan Kettering Cancer Center, which was used in conducting this investigation. The authors declare no financial relationship with the organization that sponsored this research. The authors have full control of all primary data and allow review of our data if requested.
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Richard D. Carvajal and Jennifer L. Hay are co-last authors.
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Shuk, E., Shoushtari, A.N., Luke, J. et al. Patient perspectives on ipilimumab across the melanoma treatment trajectory. Support Care Cancer 25, 2155–2167 (2017). https://doi.org/10.1007/s00520-017-3621-z
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DOI: https://doi.org/10.1007/s00520-017-3621-z