Metastatic melanoma patients at the highest risk of death are more likely than lower-risk patients to receive immune checkpoint inhibitors (ICIs) near the end of their life, according to research published in The Oncologist.

These results, obtained via a model that predicts risk of death in metastatic melanoma patients, suggest that prognostic risk stratification could guide interventions in early palliative care to optimize appropriate use of ICIs and to improve end-of-life care, researchers reported.

In this study, the researchers used electronic health records to assess baseline clinical and laboratory factors correlated with poor prognosis for 398 patients with metastatic melanoma treated with ICIs. The researchers then identified prognostic subgroups to determine association with end-of-life outcomes and to evaluate whether end-of-life care varied across categories of prognostic stratification.

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The researchers determined that the factors associated with overall survival included performance status, liver metastases, lactate dehydrogenase, lung metastases, prior therapies, and neutrophil/lymphocyte ratio. Through multivariable analyses, the researchers then developed risk scores to stratify patients by risk of death.

Among the 398 patients studied, 133 were categorized as low risk, 133 as medium risk, and 132 as high risk. Overall, 205 patients died, including 45 (34%) in the low-risk group, 63 (47%) in the medium-risk group, and 97 (73%) in the high-risk group.

High-risk patients were found to be more likely to receive ICIs near the end of life. Within 2 weeks of death, 9.5% of high-risk patients received ICIs, compared to 4% of low-risk patients and 0% of medium-risk patients (P =.043).

Similarly, within 30 days of death, 30% of high-risk patients received ICIs, compared with 14% of low-risk patients and 8.5% of medium-risk patients (P =.002). Within 90 days of death, 58% of high-risk patients received ICIs compared with 35% of low-risk patients and 34% of medium-risk patients (P =.004).

“The implications of our study are notable, as it shows that patients with metastatic melanoma at highest risk of death are more likely to receive ICI therapy closer to death,” the researchers concluded. “These patients should be considered for earlier palliative care comanagement strategies to facilitate treatment decision-making, to inform serious-illness conversations, and to ensure that personal goals and values are honored at the end of life.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Grad RN, Jung S, Ye F, Sun L, Johnson DB, Agarwal R. Prognostic risk stratification and end-of-life care outcomes in patients with metastatic melanoma treated with immune checkpoint inhibitors. Published online August 5, 2023. Oncologist. doi:10.1093/oncolo/oyad219