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Understanding Real-World Treatment Patterns and Clinical Outcomes among Metastatic Melanoma Patients in Alberta,
Dylan E O'Sullivan1,2,3,4, Devon J Boyne2,3,4, Priyanka Gogna5
1Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB T2S 3C3, Canada.
Abstract:
Immunotherapy and targeted therapies have been shown to considerably improve long-term survival outcomes in metastatic melanoma patients. Real-world evidence on the uptake of novel therapies and outcomes for this patient population in Canada are limited. We conducted a population-based retrospective cohort study of all metastatic melanoma patients diagnosed in Alberta, Canada (2015-2018) using electronic medical records and administrative data. Information on BRAF testing for patients diagnosed in 2017 or 2018 was obtained through chart abstraction. In total, 434 metastatic melanoma patients were included, of which 110 (25.3%) were de novo metastatic cases. The median age at diagnosis was 66 years (IQR: 57-76) and 70.0% were men. BRAF testing was completed for the majority of patients (88.7%). Among all patients, 60.4%, 19.1%, and 6.0% initiated first-line, second-line, and third-line systemic therapy. The most common therapies were anti-PD-1 and targeted therapies. The two-year survival probability from first-line therapy, second-line therapy, and third-line therapy was 0.50 (95% CI: 0.44-0.57), 0.26 (95% CI: 0.17-0.40), and 0.14 (95% CI: 0.40-0.46), respectively. In the first-line setting, survival was highest for patients that received ipilimumab or ipilimumab plus nivolumab, while targeted therapy had the highest survival in the second-line setting. This study indicates that novel therapies improve survival in the real world but a considerable proportion of patients do not receive treatment with systemic therapy.
Insights
Novel immunotherapies and targeted treatments significantly improve survival for metastatic melanoma patients in Canada. However, a notable number of patients do not receive these life-extending systemic therapies.
Area of Science:
- Oncology
- Clinical Research
- Public Health
Background:
- Metastatic melanoma survival has improved due to immunotherapy and targeted therapies.
- Real-world data on novel therapy uptake and outcomes in Canadian metastatic melanoma patients is scarce.
Purpose of the Study:
- To evaluate the real-world uptake of novel systemic therapies and their impact on survival outcomes in metastatic melanoma patients in Alberta, Canada.
- To assess the proportion of patients receiving first-line, second-line, and third-line treatments.
Main Methods:
- Population-based retrospective cohort study of 434 metastatic melanoma patients diagnosed between 2015-2018 in Alberta.
- Utilized electronic medical records and administrative data; included chart abstraction for BRAF testing.
- Analyzed treatment initiation and calculated two-year survival probabilities based on therapy lines.
Main Results:
- 88.7% of patients underwent BRAF testing. 60.4%, 19.1%, and 6.0% received first-line, second-line, and third-line therapy, respectively.
- Anti-PD-1 and targeted therapies were most common. Two-year survival probabilities were 0.50, 0.26, and 0.14 for first-, second-, and third-line therapies.
- First-line ipilimumab or ipilimumab plus nivolumab showed highest survival; second-line targeted therapy also demonstrated significant survival benefits.
Conclusions:
- Novel therapies demonstrably improve real-world survival for metastatic melanoma patients.
- A significant proportion of patients do not receive systemic therapy, highlighting a gap in treatment access or utilization.
- Further research is needed to understand barriers to treatment and optimize care delivery for this population.
