AACR 2020 – Resected melanoma: real-word data on survival, treatment in the immunotherapy era


  • Cristina Ferrario — Agenzia Zoe
  • Univadis
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Takeaway

  • Adjuvant immune checkpoint inhibitors (a-ICIs) yield a survival advantage in a real-world population of patients with stage III melanoma.
  • Socioeconomic factors play a role in receiving a-ICIs.
  • Continued analyses are needed to demonstrate the real-world benefits of this treatment.

Why this matters

  • Prognosis is poor for patients with stage III melanoma even after curative-intent surgery.
  • In clinical trials, adjuvant ipilimumab (FDA approved for this indication in 2015) was associated with improved survival in some patients.
  • Real-world data are needed.

Study design

  • Stage III melanoma cases identified from the National Cancer Database.
  • Survival analysis (year 2015): 4094 patients; treatment pattern analysis (2015-2016): 8160 patients.
  • Patients grouped as a-ICIs vs no a-ICIs and excluded if they had received chemotherapy as systemic therapy.
  • Aim: to assess real-world survival data and sociodemographic factors associated with receipt of a-ICIs.
  • Funding: none declared.

Key results

  • Median OS:
    • All stage III: not yet reached in either group.
    • Stage IIIC: 32 months with a-ICIs vs 28 months with no a-ICIs.
  • 24-month survival with a-ICIs vs no a-ICIs:
    • All stage III: 83% vs 80% (P=.051).
    • Stage IIIC: 70% vs 59% (P<.01>
  • In the treatment pattern analysis group, 28% of patients received a-ICIs.
  • Patients with higher Charlson-Deyo comorbidity scores, Medicare as the primary payer, and diagnosis in 2015 were less likely to receive immunotherapy.

Limitations

  • Retrospective database.
  • Differences between specific immunotherapy agents not assessable.
  • Disease-specific survival not recorded.
  • Some sociodemographic data are unknown.

Expert commentary

  • “Implementation of this therapy was low to start,” said Antoni Ribas, professor of Medicine, Surgery, and Molecular and Medical Pharmacology at UCLA Medical Center and AACR President-Elect 2019-2020. “Data from the treatment pattern analysis highlight the negative impact of socioeconomic background on having access to therapies proven to benefit patients both in clinical trials and in the real world.”