End-of-Life Use of Systemic Therapy in Patients With Advanced Melanoma: A Nationwide Cohort Study.

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.
Competing Interests: 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.