Keytruda May Improve Quality of Life Versus Standard of Care in Post-Surgical Melanoma

Patients with high-risk melanoma reported improved quality of life when given post-surgical Keytruda (pembrolizumab) compared to those who were given a standard-of-care regimen of Yervoy (ipilimumab) or high-dose interferon-α2b, according to findings from the phase 3 SWOG S1404 trial.

“Patients with cancer, in consultation with their physicians, are routinely challenged to balance the benefits of a given treatment with the potential adverse consequences to (quality of life),” the researchers wrote in the paper published in JAMA Oncology. “Taken together with the primary clinical results, this secondary analysis of the SWOG S1404 phase 3 randomized clinical trial demonstrated that (Keytruda) conveyed superior clinical and patient-reported (quality of life) outcomes compared with standard treatment for high-risk melanoma.”

The trial included 1,303 patients with high-risk melanoma that had been surgically removed. These patients were randomly assigned to receive either Keytruda or the current standard of care.

While high-dose interferon may significantly improve relapse-free survival (time from treatment until the disease returns) in this patient population, the treatment is associated with serious and severe side effects. Similarly, Yervoy also improves relapse-free survival, but approximately half of patients had to stop treatment or decrease their dose due to side effects.

Conversely, Keytruda had a longer average relapse-free survival than the other two regimens and led to a 23% reduction in the risk for relapse.

Keytruda was approved in December 2021 for the treatment of patients with stage 2b, 2c or 3 melanoma that was fully resected.

Patients in the study were also surveyed on their quality of life at the start of the trial and after cycles 1, 3, 5, 7 and 9. Data from 832 patients was involved in the quality of life analysis and showed that Keytruda was associated with improved quality of life over high-dose interferon and Yervoy.

Researchers on the trial established that five points or higher difference on quality-of-life scales would be deemed to be a significant improvement. At cycle 3, quality of life was 9.6 points higher in the Keytruda group than it was in the interferon/Yervoy groups. An improvement of at least five points was seen with Keytruda through cycle 7.

“Physicians should be encouraged to incorporate and discuss treatment-related (quality-of-life) issues with patients when making shared decisions regarding the risks and benefits of adjuvant therapy in resected melanoma,” the study authors wrote.

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