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29.10.2019 | Melanoma

Preferences for Immunotherapy in Melanoma: A Systematic Review

Zeitschrift:
Annals of Surgical Oncology
Autoren:
RN, MHSM, GradDipHlthEc Ann Livingstone, MBBS, FRACP Anupriya Agarwal, MBBS(Hons), MSc(Clin Epi), FRACP Martin R. Stockler, BSc(Med), MBBS(Hons), FRACP, PhD Alexander M. Menzies, BSc(Hons I), MAppSci(Biopharm), MPH, MHlthEc, PhD Kirsten Howard, MScMed(Clin Epi)(Hons), PhD Rachael L. Morton
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Abstract

Background

Immunotherapy improves overall survival for patients with metatstatic melanoma and improves recurrence–free survival in the adjuvant setting, but is costly and has adverse effects. Little is known about the preferences of patients and clinicians regarding immunotherapy. This study aimed to identify factors important to patients and clinicians when deciding about immunotherapy for stages 2–4 melanoma.

Methods

This study searched the Medline, EMBASE, ECONLIT, PsychINFO, and COCHRANE Systematic Reviews databases from inception to June 2018 for immunotherapy choice and preference studies. Findings were tabulated and summarized, and study reporting was assessed against recommended checklists.

Results

This investigation identified eight studies assessing preferences for melanoma treatment; four studies regarding nivolumab, pembrolizumab, or ipilimumab; and four studies regarding interferon conducted in the United States, Germany, and Australia. The following 10 factors were important to decision-making: overall survival, recurrence-free survival, treatment side effects, dosing regimen, patient or payer cost, patient age, clinician or family/friend treatment recommendation, quality of life, and psychosocial effects. Overall survival was the most important factor for all respondents. The patients judged severe toxicities to be tolerable for small survival gains. The description of information about treatment harms and benefits was limited in most studies.

Conclusions

Overall survival was of primary importance to patients and clinicians considering immunotherapy. Impaired quality of life due to adverse effects appeared to be a second-order consideration. Future research is required to determine preferences for contemporary combination therapies, extended treatment durations, and avoidance of chronic side effects.

Systematic review registration

PROSPERO registration number CRD42018095899.

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