Background
Immunotherapy has revolutionised advanced melanoma treatment, though is associated with diverse immune-mediated toxicities which potentiate considerable morbidity. Prompt recognition is essential for timely intervention, a challenge in regional Australia where there is inequitable access to specialist services. The impact of Specialist Melanoma Nurses on toxicity management and outcomes in regional patients remains unknown. This research aims to characterise immune-mediated toxicity incidence in regional patients with advanced melanoma, and to describe Specialist Melanoma Nurse roles in toxicity identification and management.
Methodology
This retrospective cohort study collected data from three cancer care centres across a regional health district. Patients who received immunotherapy for stage III or IV melanoma between 2016-2025 were recruited. Toxicity incidence, severity, management, and Specialist Melanoma Nurse involvement data was collected and descriptively analysed. Fisher’s exact test compared nurse involvement in symptom identification with time to colitis diagnosis.
Results
A total of n=169 participants were recruited, majority male (n=112, 66.30%) with a mean age of 67.02 (SD 13.69). Most had unresectable stage III or IV melanoma (n=106, 62.72%), the remaining 37.28% (n=63) had resected disease. Most participants were treated with single agent anti-PD1 (n=124, 73.37%) and combination anti-CTLA4/PD1 (n=54, 31.95%) antibodies. Immune-related adverse events occurred in 56.80% (n=96), the most prevalent being thyroiditis (n=39, 23.08%), hepatitis (n=38, 22.49%) and colitis (n=30, 17.75%). High-grade events occurred in 31.36% (n=53). Colitis was most frequently high-grade (n=24, 80.00%), prompting immunotherapy cessation in 70.00% (n=21) of cases. Toxicity was recognised within one week of onset in most thyroiditis (n=36, 92.31%), hepatitis (n=34, 89.47%), and hypophysitis (n=10, 83.33%) cases via routine laboratory screening. Specialist Melanoma Nurse involvement in toxicity management was most documented across colitis (n=25, 83.33%), hypophysitis (n=8, 66.67%) and pneumonitis (n=5, 41.67%) cases. Symptom identification and escalation by the Specialist Melanoma Nurse in 53.33% (n=16) of colitis cases was significantly associated with earlier toxicity recognition and management (p<0.05).
Conclusion
Immune-mediated toxicity is prevalent in regional patients receiving immunotherapy for advanced melanoma, with colitis representing a high-burden toxicity. Prompt colitis recognition by the Specialist Melanoma Nurse facilitated early intervention. With acknowledged sample size limitations, further research in larger cohorts is recommended.