Characteristics and quality of life of nine-year survivors with metastatic melanoma treated with pembrolizumab beyond second-line therapy

Dugas-Breit S, Forschner A, Erdmann M, Gutzmer R, Kähler KC, Holst I, Brekner A, Franklin C, Sindrilaru A, Zimmer L, Heinzerling L, Utikal J, Meier F, Bender A, Berking C, Garbe C, Weichenthal M, Schadendorf D, Hauschild A, Gschnell M, Mohr P, Hassel JC (2026)

Publication Type: Journal article

Publication year: 2026

Journal

European Journal of Cancer Elsevier

Book Volume: 233

Article Number: 116149

DOI: 10.1016/j.ejca.2025.116149

Abstract

Background Immune checkpoint blockers have improved survival in metastatic melanoma. Long-term quality of life (QoL) and sequelae from immune-related adverse events (irAE) are therefore of increasing importance. This study reports long-term outcomes from a real-world cohort of patients with stage IV melanoma treated with pembrolizumab after progression on ipilimumab and, if indicated, BRAF/MEK inhibition. Methods Survival of patients who started treatment with pembrolizumab within the German Expanded Access Program (EAP) were evaluated in Cancer centers that included ≥ 10 patients. For survivors, baseline characteristics, best response and irAEs were assessed retrospectively. In addition, in a cross-sectional approach patients were interviewed for persisting symptoms and QoL (WHO-5, EORTC QLQ-C30). Results Of 325 treated patients, 55 (17 %) survived after a median follow-up of 9.1 years. At treatment start, survivors had a median age of 60 years; 60 % were male; 40 % BRAF-mutated; 66 % stage M1c/d. Overall response rate was 89 %, including 69 % complete responses. Progression occurred in 22 (40 %). As of May 2024, 46 (84 %) were disease-free, 7 (13 %) had controlled disease, and 2 (4 %) progressed. IrAEs occurred in 39 (71 %), with 15 (27 %) grade 3/4. Persisting symptoms were reported by 19 (35 %), mainly endocrine insufficiencies, vitiligo, and fatigue. Median WHO-5 score was 76 %, and mean QLQ-C30 global health 70.1. Survivors with prior irAEs had significantly lower QoL (WHO-5, p = 0.026) and social functioning (QLQ-C30, p = 0.046). Of 21 survivors < 65 years (38 %), 11 (20 %) were employed at follow-up. Conclusion Pembrolizumab induced long-term survival in a real-world pretreated melanoma cohort. Despite persisting symptoms in one third, QoL, when measured by standard instruments, was good for most survivors nearly a decade after treatment.

Authors with CRIS profile

Michael Erdmann Department of Dermatology Lucie Heinzerling Department of Dermatology Carola Berking Lehrstuhl für Haut- und Geschlechtskrankheiten

Involved external institutions

Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) Elbe Kliniken Stade-Buxtehude DE Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz DE Germany (DE) Universitätsklinikum Ulm DE Germany (DE) Universitätsklinikum Essen DE Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE) Deutsches Krebsforschungszentrum (DKFZ) DE Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE) Universitätsklinikum Tübingen DE Germany (DE) Johannes Wesling Klinikum Minden DE Germany (DE)

How to cite

APA:

Dugas-Breit, S., Forschner, A., Erdmann, M., Gutzmer, R., Kähler, K.C., Holst, I.,... Hassel, J.C. (2026). Characteristics and quality of life of nine-year survivors with metastatic melanoma treated with pembrolizumab beyond second-line therapy. European Journal of Cancer, 233. https://doi.org/10.1016/j.ejca.2025.116149

MLA:

Dugas-Breit, S., et al. "Characteristics and quality of life of nine-year survivors with metastatic melanoma treated with pembrolizumab beyond second-line therapy." European Journal of Cancer 233 (2026).

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