Health related quality of life outcomes for unresectable stage III or IV melanoma patients receiving ipilimumab treatment

Abstract

Background: In an international, randomized Phase III trial ipilimumab demonstrated a significant overall survival benefit in previously treated advanced melanoma patients. This report summarizes health-related quality of life (HRQL) outcomes for ipilimumab with/without gp100 vaccine compared to gp100 alone during the clinical trial's 12 week treatment induction period.

Methods: The Phase III clinical trial (MDX010-20) was a double-blind, fixed dose study in 676 previously treated advanced unresectable stage III or IV melanoma patients. Patients were randomized 3:1:1 to receive either ipilimumab (3 mg/kg q3w x 4 doses) + gp100 (peptide vaccine; 1 mg q3w x 4 doses; ipilimumab plus gp100, n = 403); gp100 vaccine + placebo (gp100 alone, n = 136); or ipilimumab + placebo (ipilimumab alone, n = 137). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) assessed HRQL. Baseline to Week 12 changes in EORTC QLQ-C30 function, global health status, and symptom scores were analyzed for ipilimumab with/without gp100 vaccine compared to gp100 alone. Mean change in scores were categorized "no change" (0-5), "a little" (5-10 points), "moderate" (10-20 points), and "very much" (>20).

Results: In the ipilimumab plus gp100 and ipilimumab alone groups, mean changes from baseline to Week 12 generally indicated "no change" or "a little" impairment across EORTC QLQ-C30 global health status, function, and symptom subscales. Significant differences in constipation, favoring ipilimumab, were observed (p < 0.05). For ipilimumab alone arm, subscales with no or a little impairment were physical, emotional, cognitive, social function, global health, nausea, pain, dyspnea, constipation, and diarrhea subscales. For the gp100 alone group, the observed changes were moderate to large for global health, role function, fatigue, and for pain.

Conclusions: Ipilimumab with/without gp100 vaccine does not have a significant negative HRQL impact during the treatment induction phase relative to gp100 alone in stage III or IV melanoma patients.

Trial registration: Clinicaltrials.gov identification number NCT00094653.

Figure 1

Baseline to Week 12 endpoint changes in EORTC QLQ-C30 function and global health status scores. * For the functioning and global health scales, improvements are indicated by positive scores. ** p > 0.05 for all comparisons. Mean change in scores were categorized as “no change” (0–5), “a little” (5–10 points), “moderate” (10–20 points), and “very much” (>20).

Figure 2

Baseline to Week 12 endpoint changes in EORTC QLQ-C30 symptom scores. * For symptom scales, improvements are indicated by negative scores. ** p < 0.05 versus gp100 group. *** p > 0.05 for all comparisons (except for Constipation with p < 0.05). Mean change in scores were categorized as “no change” (0–5), “a little” (5–10 points), “moderate” (10–20 points), and “very much” (>20).