Side effects, quality of life, and treatment adherence in melanoma patients undergoing systemic therapy

Background and objectives: In recent years, the therapeutic landscape of malignant melanoma has changed dramatically with the approval of targeted therapy and immune checkpoint inhibitors. Both therapeutic modalities are associated with a specific spectrum of side effects. It is both the occurrence of side effects and the implementation of systemic therapy that can affect the quality of life of patients. A deteriorated quality of life, in turn, may lead to poorer adherence to therapy. This article examines the current available evidence and identifies possible gaps in knowledge.Methods: Side effects that can occur during systemic therapy of malignant melanoma in the adjuvant situation and in advanced disease situations differ depending on the class of substance used. Under targeted therapy, gastrointestinal, cardiovascular, musculoskeletal, cutaneous, and ocular side effects, and fever are the most common. These side effects often resolve after dose reduction or cessation of therapy. With immune checkpoint inhibition, autoimmune side effects occur, which in principle can affect all organ systems and may be chronic or nonreversible. Especially in the situation where both forms of therapy are considered for the patient, knowledge of the patient's needs is essential for shared decision-making.Results: Since quality of life has been taken into account in study protocols only to a limited extent in a standardized and thus comparable manner so far, this should be done in the future in order to be able to compare and also evaluate new therapy options with regard to this aspect. This is especially true because the occurrence of side effects influences the quality of life of patients to different extents, depending on the course of the side effect.Conclusion: It is crucial that individual preferences concerning treatment are considered to improve therapy adherence of the patients. Melanoma patients place great value on the overall response to therapy, but not at any price if they have to accept more severe side effects. This differentiates patients and treating oncologists, who place the greatest value on side effects and give a lower priority to therapy response. Pre-existing medical conditions influence the patient's preference. Whether patients prefer immune checkpoint inhibition or targeted therapy is insufficiently investigated at the present time, whereby the form of administration also influences therapy adherence.