1
|
Dalle S, Mortier L, Corrie P, Lotem M, Board R, Arance AM, Meiss F, Terheyden P, Gutzmer R, Buysse B, Oh K, Brokaw J, Le TK, Mathias SD, Scotto J, Lord-Bessen J, Moshyk A, Kotapati S, Middleton MR. Long-term real-world experience with ipilimumab and non-ipilimumab therapies in advanced melanoma: the IMAGE study. BMC Cancer 2021; 21:642. [PMID: 34051732 PMCID: PMC8164785 DOI: 10.1186/s12885-021-08032-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Ipilimumab has shown long-term overall survival (OS) in patients with advanced melanoma in clinical trials, but robust real-world evidence is lacking. We present long-term outcomes from the IMAGE study (NCT01511913) in patients receiving ipilimumab and/or non-ipilimumab (any approved treatment other than ipilimumab) systemic therapies. Methods IMAGE was a multinational, prospective, observational study assessing adult patients with advanced melanoma treated with ipilimumab or non-ipilimumab systemic therapies between June 2012 and March 2015 with ≥3 years of follow-up. Adjusted OS curves based on multivariate Cox regression models included covariate effects. Safety and patient-reported outcomes were assessed. Results Among 1356 patients, 1094 (81%) received ipilimumab and 262 (19%) received non-ipilimumab index therapy (systemic therapy [chemotherapy, anti–programmed death 1 antibodies, or BRAF ± MEK inhibitors], radiotherapy, and radiosurgery). In the overall population, median age was 64 years, 60% were male, 78% were from Europe, and 78% had received previous treatment for advanced melanoma. In the ipilimumab-treated cohort, 780 (71%) patients did not receive subsequent therapy (IPI-noOther) and 314 (29%) received subsequent non-ipilimumab therapy (IPI-Other) on study. In the non-ipilimumab–treated cohort, 205 (78%) patients remained on or received other subsequent non-ipilimumab therapy (Other-Other) and 57 (22%) received subsequent ipilimumab therapy (Other-IPI) on study. Among 1151 patients who received ipilimumab at any time during the study (IPI-noOther, IPI-Other, and Other-IPI), 296 (26%) reported CTCAE grade ≥ 3 treatment-related adverse events, most occurring in year 1. Ipilimumab-treated and non-ipilimumab–treated patients who switched therapy (IPI-Other and Other-IPI) had longer OS than those who did not switch (IPI-noOther and Other-Other). Patients with prior therapy who did not switch therapy (IPI-noOther and Other-Other) showed similar OS. In treatment-naive patients, those in the IPI-noOther group tended to have longer OS than those in the Other-Other group. Patient-reported outcomes were similar between treatment cohorts. Conclusions With long-term follow-up (≥ 3 years), safety and OS in this real-world population of patients treated with ipilimumab 3 mg/kg were consistent with those reported in clinical trials. Patient-reported quality of life was maintained over the study period. OS analysis across both pretreated and treatment-naive patients suggested a beneficial role of ipilimumab early in treatment. Trial registration ClinicalTrials.gov, NCT01511913. Registered January 19, 2012 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01511913 Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08032-y.
Collapse
Affiliation(s)
- Stéphane Dalle
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite, France.
| | - Laurent Mortier
- Université de Lille, INSERM U1189, CHRU Lille, 59037, Lille, France
| | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB0 2QQ, UK
| | - Michal Lotem
- Hadassah Hebrew University Hospital, 91120, Jerusalem, Israel
| | - Ruth Board
- Royal Preston Hospital, Preston, PR2 9HT, UK
| | | | - Frank Meiss
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, 79104, Freiburg, Germany
| | | | - Ralf Gutzmer
- Medizinische Hochschule Hannover, 30625, Hanover, Germany
| | | | - Kelly Oh
- Syneos Health, Morrisville, NC, 27560, USA
| | - Jane Brokaw
- Bristol Myers Squibb, Princeton, NJ, 08543, USA
| | - T Kim Le
- Bristol Myers Squibb, Princeton, NJ, 08543, USA
| | | | | | | | | | | | | |
Collapse
|
2
|
Drummond-Lage AP, Pereira da Veiga CR, da Veiga CP, de Melo AC, Wainstein AJA. Can innovation increase the therapeutic options but accentuate the inequalities in the healthcare system? J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
3
|
Dai WF, Beca JM, Croxford R, Isaranawatchai W, Menjak IB, Petrella TM, Mittmann N, Earle CC, Gavura S, Hanna TP, Chan KKW. Real-world comparative effectiveness of second-line ipilimumab for metastatic melanoma: a population-based cohort study in Ontario, Canada. BMC Cancer 2020; 20:304. [PMID: 32293341 PMCID: PMC7158109 DOI: 10.1186/s12885-020-06798-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background For novel cancer treatments, effectiveness in clinical practice is not always aligned with clinical efficacy results. As such it is important to understand a treatment’s real-world effectiveness. We examined real-world population-based comparative effectiveness of second-line ipilimumab versus non-ipilimumab treatments (chemotherapy or targeted treatments). Methods We used a cohort of melanoma patients receiving systemic treatment for advanced disease since April 2005 from Ontario, Canada. Patients were identified from provincial drug databases and the Ontario Cancer Registry who received second-line ipilimumab from 2012 to 2015 (treated) or second-line non-ipilimumab treatment prior to 2012 (historical controls). Historical controls were chosen, to permit the most direct comparison to pivotal trial findings. The cohort was linked to administrative databases to identify baseline characteristics and outcomes. Kaplan-Meier curves and multivariable Cox regression models were used to assess overall survival (OS). Observed potential confounders were adjusted for using inverse probability of treatment weighting (IPTW). Results We identified 329 patients with metastatic melanoma (MM) who had received second-line treatments (189 treated; 140 controls). Patients receiving second-line ipilimumab were older (61.7 years vs 55.2 years) compared to historical controls. Median OS were 6.9 (95% CI: 5.4–8.3) and 4.95 (4.3–6.0) months for ipilimumab and controls, respectively. The crude 1-year, 2-year, and 3-year OS probabilities were 34.3% (27–41%), 20.6% (15–27%), and 15.2% (9.6–21%) for ipilimumab and 17.1% (11–23%), 7.1% (2.9–11%), and 4.7% (1.2–8.2%) for controls. Ipilimumab was associated with improved OS (IPTW HR = 0.62; 95% CI: 0.49–0.78; p < 0.0001). Conclusions This real-world analysis suggests second-line ipilimumab is associated with an improvement in OS for MM patients in routine practice.
Collapse
Affiliation(s)
- Wei Fang Dai
- Cancer Care Ontario, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Jaclyn M Beca
- Cancer Care Ontario, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Ruth Croxford
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Wanrudee Isaranawatchai
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.,St Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ines B Menjak
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Teresa M Petrella
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Nicole Mittmann
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Toronto, Ontario, M4N 3M5, Canada
| | - Craig C Earle
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Institute of Clinical Evaluative Sciences, Queen's University, Kingston, ON, Canada
| | - Kelvin K W Chan
- Cancer Care Ontario, Toronto, ON, Canada. .,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Toronto, Ontario, M4N 3M5, Canada.
| |
Collapse
|
4
|
Li D, Duan H, Jiang P, Jiang X, He Z, Guo C, Mou Y. Trend and socioeconomic disparities in survival outcome of metastatic melanoma after approval of immune checkpoint inhibitors: a population-based study. Am J Transl Res 2020; 12:3767-3779. [PMID: 32774733 PMCID: PMC7407724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/26/2020] [Indexed: 12/08/2022]
Abstract
BACKGROUND The approval of immune checkpoint inhibitors (ICI) for metastatic melanoma in 2011 has changed the treatment landscape of this disease. However, current trend of the population-based survival remains unclear. METHODS 8078 patients with metastatic melanoma diagnosed in the pre-ICI (2005-2010) and post-ICI period (2011-2016) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) program for survival comparison. Propensity score matching (PSM) was performed to reduce selection bias. Cox proportional hazards model was applied for identifying survival-related factors and constructing a prognostic nomogram. The accuracy of the nomogram was determined by concordance index (C-index), calibration curves, and validated by an internal cohort. RESULTS Patients in the post-ICI period had a significantly longer median overall survival (OS) than those in the pre-ICI period, even after performing PSM between the two periods. We also found socioeconomic disparities in the survival improvement. Significant differences in OS between the two periods were only observed in cases with medical insurance and patients living in urban or low-poverty area, but not uninsured cases and patients from rural or high-poverty area. For patients in the post-ICI period, multivariate analysis demonstrated that socioeconomic and insurance status were independent prognostic factors, which can be combined with other clinical variates into a nomogram for OS prediction with promising C-index of 0.672 and 0.650 in the training- and testing cohort, respectively. CONCLUSION An overall trend to favorable survival at the population level and socioeconomic disparities in the survival trend are observed in metastatic melanoma after the ICI approval. The proposed nomogram is available for prognostication in the current melanoma management.
Collapse
Affiliation(s)
- Depei Li
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Hao Duan
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Pingping Jiang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhou, China
| | - Xiaobing Jiang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Zhenqiang He
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Chengcheng Guo
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer CenterGuangzhou, China
| | - Yonggao Mou
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer CenterGuangzhou, China
| |
Collapse
|
5
|
Cowey CL, Liu FX, Black-Shinn J, Stevinson K, Boyd M, Frytak JR, Ebbinghaus SW. Pembrolizumab Utilization and Outcomes for Advanced Melanoma in US Community Oncology Practices. J Immunother 2019; 41:86-95. [PMID: 29252916 PMCID: PMC5811239 DOI: 10.1097/cji.0000000000000204] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The programmed death-1 inhibitor pembrolizumab has demonstrated efficacy and safety in clinical trials for treating advanced (unresectable/metastatic) melanoma. We investigated the real-world utilization of pembrolizumab and associated patient outcomes for advanced melanoma in US community oncology practices. This retrospective, observational study used deidentified data from electronic health records for adult patients with advanced melanoma who received pembrolizumab at The US Oncology Network sites from September 2014 through December 2015, with follow-up through September 2016. Patients enrolled in clinical trials were excluded. Overall survival (OS) and physician-stated progression-free survival (PFS) were analyzed from pembrolizumab initiation using Kaplan-Meier, and associations between pembrolizumab therapy and OS/PFS, using multivariable Cox regression. Of 168 patients studied, 110 (65%) were male; the median age was 66 years (range, 26–over 90). Pembrolizumab was prescribed as first-line, second-line, and third-line/later for 39 (23%), 87 (52%), and 42 (25%) patients, respectively. In total, 41 patients (24%) had brain metastases. At pembrolizumab initiation, 21/129 (16%) had Eastern Cooperative Oncology Group performance status (ECOG PS) >1; 51/116 (44%) had elevated lactate dehydrogenase. Median follow-up was 10.5 months (range, 0–25.1); median OS was 19.4 months (95% confidence interval, 14.0–not reached); median PFS was 4.2 months (95% confidence interval, 2.9–5.3). Brain metastases, ECOG PS>1, elevated lactate dehydrogenase, and third-line/later (vs. first-line) pembrolizumab were significant predictors (P<0.01) of decreased survival. Treatment-related toxicity was a discontinuation reason for 25% (29/117) of patients, and for 10 of these 29 patients (6% of the full-study cohort) treatment-related toxicity was the only reported reason. The real-world effectiveness and safety of pembrolizumab for advanced melanoma are consistent with clinical trial findings.
Collapse
Affiliation(s)
- C Lance Cowey
- McKesson Specialty Health/The US Oncology Network, The Woodlands.,Skin Malignancy Research and Treatment Center, Baylor University Medical Center.,Texas Oncology PA, Dallas, TX
| | | | | | | | - Marley Boyd
- McKesson Specialty Health/The US Oncology Network, The Woodlands
| | | | | |
Collapse
|
6
|
Tarhini A, Atzinger C, Gupte-Singh K, Johnson C, Macahilig C, Rao S. Treatment patterns and outcomes for patients with unresectable stage III and metastatic melanoma in the USA. J Comp Eff Res 2019; 8:461-473. [PMID: 30832505 DOI: 10.2217/cer-2019-0003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe treatment patterns and outcomes of patients with unresectable stage III and metastatic/stage IV melanoma. Materials & methods: An observational retrospective chart review of patients diagnosed with advanced melanoma before 1 November 2015 who initiated a new line of therapy (LOT) from 1 January 2015 to 31 May 2016. Results: Among 487 patients, ipilimumab monotherapy (27.5%) was the most common first line of therapy (1LOT) in 2015, surpassed by nivolumab monotherapy (21.5%) in 2016. 12-month survival was ≥80.1%; proportions were highest forpatients treated with nivolumab + ipilimumab (86.6%). All treatments relatively well tolerated in real-world setting and adverse events were consistent with the previously reported safety profiles. Conclusion: This study provides important insights into real-world advanced melanoma treatment patterns and demonstrates encouraging treatment safety and patient survival data.
Collapse
Affiliation(s)
- Ahmad Tarhini
- Department of Hematology & Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH 441062, USA
| | | | | | | | | | - Sumati Rao
- Bristol-Myers Squibb, Princeton, NJ 086484, USA
| |
Collapse
|
7
|
Vemurafenib in BRAF-mutant metastatic melanoma patients in real-world clinical practice: prognostic factors associated with clinical outcomes. Melanoma Res 2019; 28:326-332. [PMID: 29750749 DOI: 10.1097/cmr.0000000000000453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this population-based study was to identify the factors associated with clinical outcomes in vemurafenib-treated patients and to evaluate outcomes across subgroups of patients with different risk profiles. Data were retrieved from the Dutch Melanoma Treatment Registry. Time to next treatment (TTNT) and overall survival (OS) of all metastatic melanoma patients who received vemurafenib between 2012 and 2015 were assessed using Kaplan-Meier estimates. A risk score was developed on the basis of all prognostic factors associated with TTNT and OS derived from multivariable Cox regression analyses. Patients were stratified according to the presence of prognostic risk factors by counting the number of factors, ranging from 0 to 6. A total of 626 patients received vemurafenib with a median follow-up of 35.8 months. The median TTNT and OS were 4.7 months [95% confidence intervals (CI): 4.4-5.1] and 7.3 months (95% CI: 6.6-8.0). The strongest prognostic factors were serum lactate dehydrogenase (LDH) level, Eastern Cooperative Oncology Group performance score, number of organ sites involved and brain metastases. Patients with a favourable risk profile (no risk factors) had a median TTNT and OS of 7.1 (95% CI: 5.8-8.5) and 15.4 months (95% CI: 10.0-20.9). The median OS more than halved for patients with greater than or equal to 2 risk factors compared with patients with no risk factors. The clinical outcomes of vemurafenib in metastatic melanoma patients with a favourable risk profile are comparable with the results of the trials. Combining prognostic factors into a risk score could be valuable to stratify patients into favourable and poor-prognosis groups.
Collapse
|
8
|
Liede A, Hernandez RK, Wade SW, Bo R, Nussbaum NC, Ahern E, Dougall WC, Smyth MJ. An observational study of concomitant immunotherapies and denosumab in patients with advanced melanoma or lung cancer. Oncoimmunology 2018; 7:e1480301. [PMID: 30524886 DOI: 10.1080/2162402x.2018.1480301] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/20/2018] [Indexed: 02/08/2023] Open
Abstract
After a case report of profound clinical response in a melanoma patient following treatment with an immune checkpoint inhibitor (ICI) and RANK-ligand inhibitor denosumab, we identified similar patients from electronic health records (EHR) and described patient characteristics and outcomes. This 2017 observational study used Flatiron Health's EHR database from ~255 US cancer clinics. Included were advanced melanoma or non-small-cell lung cancer (NSCLC) patients who received denosumab within 30 days of CTLA-4 (ipilimumab) or PD1 (pembrolizumab, nivolumab) inhibitors start with a minimum of 6 months of follow up. Real-world tumor response (rwTR) was analyzed for scans available up to 30 days after concomitant therapy. Preclinical experiments evaluated sequencing of ICI, denosumab vs monotherapy or control. Melanoma (n = 66) patients received concomitant denosumab/ICI for a mean 4.0 months, 3.1 months for NSCLC (n = 241). Two-thirds of patients had best rwTR evaluable (complete [CR], partial response [PR], stable disease [SD], or disease progression [PD]). Longer mean duration of concomitant exposure was associated with overall response rate (ORR; CR+PR) in melanoma (p = 0.0172), NSCLC (p < .0001), and combined cohorts (p < .0001). The disease control rate (ORR plus SD) was 56% amongst melanoma patients and 58% amongst NSCLC patients. Longer concomitant therapy was associated with increased overall survival, primarily in NSCLC (p < .0001). Preclinical data suggest that ICI initiated before or at same time as denosumab was optimal. Results provide proof-of-concept that rwTR is associated with concomitant denosumab/ICI. Crude survival analyses supported the association of concomitant therapy and improved outcomes outside of clinical trials and warrant comparative study.
Collapse
Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA
| | - Rohini K Hernandez
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA
| | - Sally W Wade
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA.,Wade Outcomes Research and Consulting, Salt Lake City, Utah, USA
| | - Ronghai Bo
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA
| | - Nathan C Nussbaum
- Flatiron Health, New York, USA.,Department of Medicine, New York University School of Medicine, New York, USA
| | - Elizabeth Ahern
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia.,Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - William C Dougall
- Immuno-oncology Discovery Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Mark J Smyth
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| |
Collapse
|
9
|
Hanna TP, Nguyen P, Baetz T, Booth CM, Eisenhauer E. A Population-based Study of Survival Impact of New Targeted and Immune-based Therapies for Metastatic or Unresectable Melanoma. Clin Oncol (R Coll Radiol) 2018; 30:609-617. [PMID: 30196844 DOI: 10.1016/j.clon.2018.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022]
Abstract
AIMS New targeted drugs and immune therapies reported since 2010 for metastatic or unresectable melanoma (MM) have shown improved survival in randomised trials. We studied the uptake of these new drugs and their impact on population-based survival. MATERIALS AND METHODS This was a retrospective, population-based cohort study of all patients treated for MM in Ontario 2007-2015. Provincial administrative sources covering the whole population identified palliative systemic therapy, radiotherapy and metastasis surgery. Temporal trends in utilisation and survival were investigated, as was survival of treatments predefined as 'new drugs' (BRAF or MEK inhibitors, anti-CTLA4 and anti-PD-1 antibodies). RESULTS We identified 2793 treated MM patients. First treatment was systemic therapy (46%), radiotherapy (41%) and metastasis surgery (14%). Systemic treatment increased from 53% of patients (2007) to 75% (2015). New drug treatments increased from <6% of known first-line regimens in 2007 to 82% in 2015. One and 2 year overall survival was 28% and 15%, respectively, for all MM 2007-2009, rising to 46% and 35% for 2014-2015 (adjusted hazard ratio 0.56, 95% confidence interval 0.49-0.63, P < 0.0001). Survival gains were observed primarily among those cases initially treated with systemic therapy, which became dominated by the use of new drugs over the study period (2 year overall survival 16% 2007-2009 versus 44% 2014-2015; adjusted hazard ratio 0.46, 95% confidence interval 0.38-0.56, P < 0.0001). CONCLUSIONS Utilisation of new targeted drugs and immune therapies for MM has increased considerably in routine practice 2007-2015. Consistent with the results of clinical trials, adoption was associated with substantial increases in survival of patients in the general population.
Collapse
Affiliation(s)
- T P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences at Queen's University, Kingston, Ontario, Canada.
| | - P Nguyen
- Institute for Clinical Evaluative Sciences at Queen's University, Kingston, Ontario, Canada
| | - T Baetz
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - C M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences at Queen's University, Kingston, Ontario, Canada
| | - E Eisenhauer
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
10
|
Gambichler T, Brown V, Steuke AK, Schmitz L, Stockfleth E, Susok L. Baseline laboratory parameters predicting clinical outcome in melanoma patients treated with ipilimumab: a single-centre analysis. J Eur Acad Dermatol Venereol 2017; 32:972-977. [DOI: 10.1111/jdv.14629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Affiliation(s)
- T. Gambichler
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - V. Brown
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - A.-K. Steuke
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Schmitz
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - E. Stockfleth
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Susok
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| |
Collapse
|
11
|
da Silveira Nogueira Lima JP, Georgieva M, Haaland B, de Lima Lopes G. A systematic review and network meta-analysis of immunotherapy and targeted therapy for advanced melanoma. Cancer Med 2017; 6:1143-1153. [PMID: 28463413 PMCID: PMC5463084 DOI: 10.1002/cam4.1001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 12/11/2022] Open
Abstract
Immune and BRAF‐targeted therapies have changed the therapeutic scenario of advanced melanoma, turning the clinical decision‐making a challenging task. This Bayesian network meta‐analysis assesses the role of immunotherapies and targeted therapies for advanced melanoma. We retrieved randomized controlled trials testing immune, BRAF‐ or MEK‐targeted therapies for advanced melanoma from electronic databases. A Bayesian network model compared therapies using hazard ratio (HR) for overall survival (OS), progression‐free survival (PFS), and odds ratio (OR) for response rate (RR), along with 95% credible intervals (95% CrI), and probabilities of drugs outperforming others. We assessed the impact of PD‐L1 expression on immunotherapy efficacy. Sixteen studies evaluating eight therapies in 6849 patients were analyzed. For OS, BRAF‐MEK combination and PD‐1 single agent ranked similarly and outperformed all other treatments. For PFS, BRAF‐MEK combination surpassed all other options, including CTLA‐4‐PD‐1 dual blockade hazard ratio (HR: 0.56; 95% CrI: 0.33–0.97; probability better 96.2%), whereas BRAF single agent ranked close to CTLA‐4‐PD‐1 blockade. For RR, BRAF‐MEK combination was superior to all treatments including CTLA‐4‐PD‐1 (OR: 2.78; 1.18–6.30; probability better 97.1%). No OS data were available for CTLA‐4‐PD‐1 blockade at the time of systematic review, although PFS and RR results suggested that this combination could also bring meaningful benefit. PD‐L1 expression, as presently defined, failed to inform patient selection to PD‐1‐based immunotherapy. BRAF‐MEK combination seemed an optimal therapy for BRAF‐mutated patients, whereas PD‐1 inhibitors seemed optimal for BRAF wild‐type patients. Longer follow‐up is needed to ascertain the role of CTLA‐4‐PD‐1 blockade. Immunotherapy biomarkers remain as an unmet need.
Collapse
Affiliation(s)
| | - Mina Georgieva
- Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Benjamin Haaland
- Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | |
Collapse
|
12
|
Le AD, Alzghari SK, Jean GW, La-Beck NM. Update on targeted therapies for advanced non-small cell lung cancer: nivolumab in context. Ther Clin Risk Manag 2017; 13:223-236. [PMID: 28260909 PMCID: PMC5328134 DOI: 10.2147/tcrm.s104343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
While the initial treatment of non-small cell lung cancer (NSCLC) usually relies on surgical resection followed by systemic cytotoxic chemotherapy and/or radiation therapy, recent advances in understanding of NSCLC biology and immunology have spurred the development of numerous targeted therapies. In particular, a class of immune modulatory drugs targeting the immune checkpoint pathways has demonstrated remarkable durable remissions in a select minority of advanced NSCLC patients, potentially heralding the elusive “cancer cure”. This review focuses on the clinical evidence for one of these agents, nivolumab, and clarifies the role of this drug in the context of the other targeted therapies currently available for the treatment of NSCLC. We also discuss the impact of nivolumab on patient quality of life and health economics.
Collapse
Affiliation(s)
- Alexander D Le
- Department of Immunotherapeutics and Biotechnology, School of Pharmacy, Texas Tech University Health Sciences Center, Abilene
| | - Saeed K Alzghari
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Gary W Jean
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Ninh M La-Beck
- Department of Immunotherapeutics and Biotechnology, School of Pharmacy, Texas Tech University Health Sciences Center, Abilene
| |
Collapse
|
13
|
Middleton MR, Dalle S, Claveau J, Mut P, Hallmeyer S, Plantin P, Highley M, Kotapati S, Le TK, Brokaw J, Abernethy AP. Real-world treatment practice in patients with advanced melanoma in the era before ipilimumab: results from the IMAGE study. Cancer Med 2016; 5:1436-43. [PMID: 27118102 PMCID: PMC4944869 DOI: 10.1002/cam4.717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 11/21/2022] Open
Abstract
The therapeutic landscape for advanced melanoma has recently been transformed by several novel agents (immune checkpoint inhibitors and molecular‐targeted agents). The prospective, multi‐site, observational study IMAGE (ipilimumab: management of advanced melanoma in real practice) included a retrospective cohort to describe real‐world treatment prior to approval of the immune checkpoint inhibitor ipilimumab. This retrospective cohort of patients, who started second‐line/subsequent treatment (index therapy) for advanced melanoma within 3 years before ipilimumab approval, was selected randomly by chart review. Collected data included treatment history, patient outcomes, and healthcare resource utilization. All patients had ≥1 year of follow‐up data. This analysis included 177 patients from Europe (69%) and North America (31%). The most common index therapies (used alone or in combination) were fotemustine (23%), dacarbazine (21%), temozolomide (14%), and platinum‐based chemotherapy (14%). Most patients (89%) discontinued index treatment during the study period; the most common reason was disease progression (59%). Among patients with tumor assessment (153/177; 86%), 2% had complete response, 5% had partial response, and 12% had stable disease on last tumor assessment. At 1‐year study follow‐up, median progression‐free survival was 2.6 months (95% confidence interval [CI], 2.1–2.9) and median overall survival was 8.8 months (95% CI, 6.5–9.7). During follow‐up, 95% of the patients had healthcare visits for advanced melanoma, 74% of whom were hospitalized or admitted to a hospice facility. These results provide insights into patient care with advanced melanoma in the era before ipilimumab and may serve as a benchmark for new agents in future real‐world studies.
Collapse
Affiliation(s)
- Mark R Middleton
- National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | | | - Joel Claveau
- Centre Hospitalier Universitaire de Québec, Quebec City, Canada
| | - Pilar Mut
- Hospital Son Llatzer, Illes Balears, Spain
| | | | | | - Martin Highley
- Plymouth Oncology Centre, Derriford Hospital, Plymouth, United Kingdom
| | | | | | | | | |
Collapse
|