Real-World Treatment Patterns in Advanced Cutaneous Melanoma in the USA

Area of Science:

• Oncology
• Medical Informatics
• Pharmacoeconomics

Background:

• Advanced melanoma has poor prognosis despite systemic therapy advances.
• Disease progression is common, necessitating effective second-line treatments.
• Understanding real-world treatment sequencing is crucial for improving patient outcomes.

Purpose of the Study:

• To characterize real-world treatment patterns in US patients with advanced cutaneous melanoma.
• To analyze transitions from first-line (1L) to second-line (2L) systemic therapy.
• To investigate treatment sequencing based on BRAF V600 mutation status.

Main Methods:

• Retrospective analysis of administrative claims data from a US managed care database.
• Inclusion of adult patients with metastatic melanoma initiating 1L therapy (Jan 2023-Dec 2025) and receiving 2L therapy.
• Claims-based algorithms to identify treatment regimens; Sankey diagrams for visualizing transitions.

Main Results:

• Immune checkpoint inhibitor (ICI)-based regimens were the most common 1L therapy (78.5%).
• Second-line (2L) therapy patterns were diverse; BRAF + MEK inhibitors were most frequent (27.5%).
• BRAF + MEK inhibitors predominated in 2L for BRAF-mutated patients (71.8%), while ICI-based regimens dominated in BRAF wild-type patients (84.9%).

Conclusions:

• Treatment practices for advanced melanoma are evolving, but optimal 2L sequencing remains uncertain.
• Significant differences exist in 2L treatment selection based on BRAF mutation status.
• Prospective studies and novel therapeutic options are needed for post-progression treatment.