Immunotherapy utilization in stage IIIA melanoma: less may be more

Area of Science:

• Oncology
• Melanoma Research
• Immunotherapy

Background:

• Adjuvant immunotherapy is approved for stage III melanoma, but survival benefit data for early stage IIIA disease is limited.
• Current guidelines for adjuvant immunotherapy in stage IIIA melanoma rely on clinical judgment, leading to prescribing variations.
• This study investigated practice variations and patient outcomes associated with adjuvant immunotherapy in stage IIIA melanoma.

Purpose of the Study:

• To characterize current variations in adjuvant immunotherapy prescribing patterns for stage IIIA melanoma.
• To compare patient outcomes, specifically overall survival, based on different immunotherapy prescribing practices.
• To identify factors influencing the utilization of adjuvant immunotherapy in stage IIIA melanoma patients.

Main Methods:

• Retrospective analysis of 4,432 stage IIIA melanoma patients diagnosed between 2015-2019 from the National Cancer Database.
• Utilized multivariable Cox proportional hazards regression to compare overall survival across different treatment groups.
• Identified factors associated with receiving adjuvant immunotherapy, including treatment center type and volume.

Main Results:

• 34% of eligible patients received adjuvant immunotherapy.
• Patients treated at academic or high-volume centers had lower odds of receiving immunotherapy compared to community or low-volume centers.
• Immunotherapy receipt was not significantly associated with overall survival (p=0.095), while high-volume centers showed improved survival (HR=0.52, p=0.030).

Conclusions:

• Academic and high-volume centers use less adjuvant immunotherapy in stage IIIA melanoma than community and low-volume centers.
• This reduced utilization did not compromise overall survival in stage IIIA melanoma patients.
• Findings suggest that more judicious application of adjuvant immunotherapy may be beneficial for this patient population.