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Updated: Aug 14, 2026
Quantitation of Endothelial Cell Adhesiveness In Vitro
Published on: June 18, 2015
Metastatic melanoma patient outcomes since introduction of immune checkpoint inhibitors in England between 2014 and
Ruth Board1, Rebecca Smittenaar2, Sarah Lawton2
1Department of Oncology, Lancashire Teaching Hospitals NHS Trust, Preston, UK.
Abstract:
Immune checkpoint inhibitors (CPIs) have radically changed outcomes for patients diagnosed with metastatic melanoma globally in the last 10 years, based on evidence of overall survival (OS) benefits generated from international randomised controlled trials (RCTs). Since RCTs do not always reflect real-world prescribing, we interrogated established national databases to track prescribing of CPIs approved for first line treatment of metastatic melanoma patients in England since 2014 and determined patient outcomes associated with OS, as well as treatment-related toxicity. Between April 2014 and March 2018, 5465 melanoma patients were diagnosed and treated with systemic anticancer therapy (SACT), 2322 of which received first-line CPIs. There was good 3-year OS concordance with RCT outcomes for ipilimumab (32%), ipinivo (56%) and nivolumab (51%), but OS was lower than expected for pembrolizumab (40%). Comparing patients prescribed ipinivo with those prescribed pembrolizumab, ipinivo-treated patients were younger (88% vs 49% patients <70 years, P < .001) and fitter (60% vs 38% patients with Eastern Cooperative Oncology Group [ECOG] performance status 0, P < .0001). Emergency hospital admission rates from the earliest and last treatment dates were higher for patients prescribed ipinivo (37% and 55%) compared to those prescribed pembrolizumab (17% and 29%). The 30-day mortality rates favoured ipinivo patients (3.8% ipinivo, 9.1% pembrolizumab, P < .0001) and likely reflected marked differences in median treatment durations: 63 (range 7-440) days for ipinivo and 192 (range 5-943) days for pembrolizumab. The dominant treatment-related condition linked to hospital admission was colitis, recorded for 25% of patients prescribed ipinivo compared to 4% of patients prescribed pembrolizumab. Our population data has demonstrated that RCT outcomes can be achieved in routine care settings with careful patient selection.
Insights
Immune checkpoint inhibitors (CPIs) improved metastatic melanoma survival, but real-world outcomes varied. Real-world data showed good overall survival (OS) concordance with trials for some CPIs, but lower for pembrolizumab, with differences in patient characteristics and toxicity observed.
Area of Science:
- Oncology
- Immunotherapy
- Real-world evidence
Background:
- Immune checkpoint inhibitors (CPIs) have transformed metastatic melanoma treatment.
- Randomized controlled trials (RCTs) demonstrate overall survival (OS) benefits but may not reflect real-world practice.
Purpose of the Study:
- To analyze real-world prescribing patterns of first-line CPIs for metastatic melanoma in England.
- To compare patient outcomes, including OS and treatment-related toxicity, with RCT data.
Main Methods:
- Utilized national databases to track CPI prescribing from April 2014 to March 2018.
- Analyzed data for 2322 patients receiving first-line CPIs, comparing outcomes for ipilimumab, nivolumab, and pembrolizumab.
Main Results:
- 3-year OS showed concordance with RCTs for ipilimumab, ipilimumab/nivolumab, and nivolumab, but was lower for pembrolizumab.
- Ipilimumab/nivolumab-treated patients were younger and fitter than pembrolizumab-treated patients.
- Higher emergency hospital admission rates and colitis incidence were observed with ipilimumab/nivolumab compared to pembrolizumab.
Conclusions:
- Real-world outcomes for metastatic melanoma patients treated with CPIs can align with RCT findings.
- Careful patient selection is crucial for achieving optimal outcomes in routine care settings.
- Differences in patient demographics and toxicity profiles necessitate careful consideration when choosing CPIs.
