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@ARTICLE{Forschner:299594,
      author       = {A. Forschner and K. C. Kähler and M. Gschnell and E. A.
                      Langan and C. Weishaupt and F. Meiss and K.-M. Thoms and R.
                      U. Wahl and D. Göppner and M. Garzarolli and M. Sachse and
                      M. Schlaak and M. Reitmajer and I. Kellner and A. Gesierich
                      and P. Mohr and F. Meier and I. von Wasielewski and R.
                      Herbst and J. Utikal$^*$ and C. Pföhler and J. Ulrich and
                      P. Terheyden and M. Kaatz and S. Haferkamp and U. Leiter and
                      S. Ugurel$^*$ and M. Weichenthal and C. Berking and R.
                      Gutzmer and D. Schadendorf$^*$ and L. Nanz and C. Loquai},
      title        = {{T}reatment at the end of life in patients with advanced
                      melanoma. {A} multicenter {D}e{COG} study of 1067 patients
                      from the prospective skin cancer registry {ADOR}eg.},
      journal      = {Frontiers in immunology},
      volume       = {16},
      issn         = {1664-3224},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2025-00535},
      pages        = {1509886},
      year         = {2025},
      abstract     = {Although systemic therapies have improved considerably over
                      the last decade, up to $50\%$ of patients with metastatic
                      melanoma still die due to disease progression. Oncological
                      treatment at the end-of-life phase is challenging. The aim
                      of this study was to investigate the frequency and type of
                      systemic therapy received by melanoma patients in their
                      end-of-life phase.Patients with metastatic melanoma who had
                      died between January 1, 2018 and October 31, 2022 were
                      identified from the prospective multicenter skin cancer
                      registry ADOReg. Study endpoints were percentage of patients
                      who had been treated with systemic therapy within the last
                      three months of life, timepoint of initiation of the
                      last-line therapy, overall survival, treatment benefit and
                      the incidence of treatment-related adverse events.In total,
                      1067 patients from 46 skin cancer centers were included.
                      Most of the patients $(63\%)$ had received immune checkpoint
                      inhibitors (ICI) as last-line therapy, $22\%$ targeted
                      therapies (TT) and $12\%$ chemotherapy (CTX). Comparing
                      last-line ICI and TT, patients with TT were significantly
                      more likely to benefit from treatment and had significantly
                      fewer and milder treatment-related AE than patients with
                      ICI. Even though two thirds of patients had received ICI as
                      a last-line therapy, the majority of these patients $(61\%)$
                      had stopped therapy within the last 30 days of life, whereas
                      the majority of patients with TT $(66\%)$ still continued
                      their treatment to the end of life. We found markedly fewer
                      patients with initiation of ICI within 30 days before their
                      death $(19\%)$ compared to a historic cohort including
                      patients who died in 2016 or 2017 $(39\%).Treatment$
                      approaches near the end of life have markedly changed in
                      skin cancer centers in Germany over recent years, with ICI
                      prescribed less frequently in the end-of-life phase. In
                      contrast, TT are frequently administered, even within the
                      last 30 days of life. It should also be considered that
                      discontinuation of TT can result in rapid tumor progression.
                      Due to the oral administration and a low rate of severe
                      toxicity, TT appear to be a suitable treatment option, even
                      in the end-of-life situation of melanoma patients.},
      keywords     = {Humans / Melanoma: drug therapy / Melanoma: mortality /
                      Melanoma: therapy / Male / Female / Registries / Skin
                      Neoplasms: drug therapy / Skin Neoplasms: mortality / Aged /
                      Middle Aged / Prospective Studies / Aged, 80 and over /
                      Terminal Care: methods / Immune Checkpoint Inhibitors:
                      therapeutic use / Immune Checkpoint Inhibitors: adverse
                      effects / Adult / Treatment Outcome / BRAF and MEK
                      inhibitors (Other) / end of life (Other) / immune checkpoint
                      inhibitors (Other) / ipilimumab (Other) / melanoma (Other) /
                      nivolumab (Other) / Immune Checkpoint Inhibitors (NLM
                      Chemicals)},
      cin          = {A370 / ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)A370-20160331 / I:(DE-He78)ED01-20160331},
      pnm          = {311 - Zellbiologie und Tumorbiologie (POF4-311)},
      pid          = {G:(DE-HGF)POF4-311},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40066437},
      pmc          = {pmc:PMC11891187},
      doi          = {10.3389/fimmu.2025.1509886},
      url          = {https://inrepo02.dkfz.de/record/299594},
}