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Bafaloukos D, Kouzis P, Gouveris P, Boukovinas I, Kalbakis K, Baka S, Kyriakakis G, Moschou D, Molfeta A, Demiri S, Mavroudis D, Spanoudi F, Dimitriadis I, Gogas H. Real-world management practices and characteristics of patients with advanced melanoma initiated on immuno-oncology or targeted therapy in the first-line setting during the period 2015-2018 in Greece. The 'SUMMER' study: a retrospective multicenter chart review project. Melanoma Res 2024; 34:152-165. [PMID: 38092014 PMCID: PMC10906211 DOI: 10.1097/cmr.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/03/2023] [Indexed: 02/02/2024]
Abstract
This study primarily aimed to generate real-world evidence (RWE) on the profile and first-line treatment (1LT) patterns of patients with advanced (unresectable Stage III/metastatic) cutaneous melanoma initiated on immuno-oncology (IO)- or targeted therapy (TT)-based 1LT between 1 January 2015 and 1 January 2018 (index period), in routine settings of Greece. This was a multicenter, retrospective chart review study. Eligible consented (unless deceased, for whom consent was waived by the hospital) patients were consecutively included by six oncology clinics. The look-back period extended from informed consent or death to initial melanoma diagnosis. Between 9 Junuary 2021 and 9 February 2022, 225 eligible patients (all Caucasians; 60.4% male; 35.6% diagnosed with de novo advanced melanoma) were included. At 1LT initiation, median age was 62.6 years; 2.7/6.7/90.7% of the patients had Stage IIIB/IIIC/IV disease and 9.3% were unresected. Most frequent metastatic sites were the lung (46.7%), non-regional nodes (33.8%), and liver (20.9%). Among patients, 98.2% had single primary melanoma, 45.6% had disease localized on the trunk, and 63.6% were BRAF-mutant. Of the patients, 45.3% initiated 1LT with an IO-based, 53.3% with a TT-based regimen, and three patients (1.3%) received TT-based followed by IO-based or vice versa. Most common 1LT patterns (frequency ≥10%) were BRAFi/MEKi combination (31.6%), anti-PD-1 monotherapy (25.3%), BRAFi monotherapy (21.8%), and anti-CTLA-4 monotherapy (17.8%). Most frequent regimens were Dabrafenib+Trametinib in 25.3%, and monotherapies with Pembrolizumab/Ipilimumab/Vemurafenib/Dabrafenib in 23.6/17.8/11.1/10.7% of patients, respectively. SUMMER provides RWE on 1LT strategies and profile of patients initiated 1L IO- or TT-based therapy in Greece during the 3-year index period.
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Affiliation(s)
| | - Panagiotis Kouzis
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine
| | | | | | | | - Sofia Baka
- Oncology Department, Interbalkan European Medical Center, Thessaloniki
| | - Georgios Kyriakakis
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine
| | - Despoina Moschou
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine
| | | | - Stamatia Demiri
- Second Department of Medical Oncology, Agios Savvas Hospital, Athens
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion
| | - Filio Spanoudi
- MSD Pharmaceutical, Industrial and Commercial S.A., Medical Affairs, Athens, Greece
| | - Ioannis Dimitriadis
- MSD Pharmaceutical, Industrial and Commercial S.A., Medical Affairs, Athens, Greece
| | - Helen Gogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine
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O'Sullivan DE, Boyne DJ, Gogna P, Brenner DR, Cheung WY. Understanding Real-World Treatment Patterns and Clinical Outcomes among Metastatic Melanoma Patients in Alberta, Canada. Curr Oncol 2023; 30:4166-4176. [PMID: 37185430 PMCID: PMC10136717 DOI: 10.3390/curroncol30040317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
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.
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Affiliation(s)
- Dylan E O'Sullivan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB T2S 3C3, Canada
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Devon J Boyne
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
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Kartolo A, Deluce J, Hopman WM, Liu L, Baetz T, Ernst S, Lenehan JG. Real-World Evidence of Systemic Therapy Sequencing on Overall Survival for Patients with Metastatic BRAF-Mutated Cutaneous Melanoma. Curr Oncol 2022; 29:1501-1513. [PMID: 35323326 PMCID: PMC8947206 DOI: 10.3390/curroncol29030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Aim: To evaluate optimal systemic therapy sequencing (first-line targeted therapy (1L-TT) vs. first-line immunotherapy (1L-IO)) in patients with BRAF-mutated metastatic melanoma. Methods: Nation-wide prospective data of patients with newly diagnosed BRAF-mutated metastatic melanoma were retrieved from the Canadian Melanoma Research Network. Results: Our study included 79 and 107 patients in the 1L-IO and 1L-TT groups, respectively. There were more patients with ECOG 0−1 (91% vs. 72%, p = 0.023) in the 1L-IO group compared to the 1L-TT group. Multivariable Cox analysis suggested no OS differences between the two groups (HR 0.838, 95%CI 0.502−1.400, p = 0.500). However, patients who received 1L-TT then 2L-IO had the longest OS compared to 1L-IO without 2L therapy, 1L-IO then 2L-TT, and 1L-TT without 2L therapy (38.3 vs. 32.2 vs. 16.9 vs. 6.3 months, p < 0.001). For patients who received 2L therapy, those who received 2L-IO had a trend towards OS improvement compared with the 2L-TT group (21.7 vs. 8.9 months, p = 0.053). Conclusions: Our nation-wide prospective study failed to establish any optimal systemic therapy sequencing in advanced BRAF-mutant melanoma patients. Nevertheless, we provided evidence that immunotherapy has durable efficacy in advanced BRAF-mutant melanoma patients, regardless of treatment line, and that Canadian medical oncologists were selecting the appropriate treatment sequences in a real-world setting, based on patients’ clinical and tumour characteristics.
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Affiliation(s)
- Adi Kartolo
- Department of Oncology, Queen’s University, Kingston, ON K7L 2V7, Canada; (A.K.); (T.B.)
| | - Jasna Deluce
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada; (J.D.); (S.E.)
| | - Wilma M. Hopman
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada;
| | - Linda Liu
- Pulse Infoframe, London, ON N5X 4E7, Canada;
| | - Tara Baetz
- Department of Oncology, Queen’s University, Kingston, ON K7L 2V7, Canada; (A.K.); (T.B.)
| | - Scott Ernst
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada; (J.D.); (S.E.)
| | - John G. Lenehan
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada; (J.D.); (S.E.)
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Nordstrom BL, Hamilton M, Collins JM, Earle D, Zhang Y, Srivastava S, Hernandez-Aya L. Treatment patterns and outcomes following disease progression on anti-PD-1 therapies for advanced melanoma. Future Oncol 2022; 18:1343-1355. [PMID: 35129375 DOI: 10.2217/fon-2021-0340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Anti-PD-1-based therapies prolong survival in advanced melanoma, but disease progression is common. This study evaluated treatment patterns and overall survival (OS) after anti-PD-1 progression. Methods: Retrospective data from patients with advanced melanoma and progression on anti-PD-1 treatment between 2014 and 2019 were taken from Flatiron Health, which reflects largely community practice. Treatment patterns and OS were analyzed for BRAF mutant (mt) and wild-type (wt) subgroups; OS was also examined across all patients. Results: Progression following anti-PD-1 was recorded for 679 patients. Median OS ranged from 5.0 to 11.3 months. Of 275 BRAFmt and 374 BRAFwt patients, 113 (41.1%) and 228 (61.0%) received no subsequent therapy, respectively. However, 48.4% of BRAFmt and 57.8% of BRAFwt patients continued anti-PD-1 treatment beyond progression. Conclusion: This real-world study underscores the need for effective treatments for advanced melanoma post-progression on anti-PD-1 therapy.
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Affiliation(s)
- Beth L Nordstrom
- Evidera, 500 Totten Pond Road, Fifth Floor, Waltham, MA 02451, USA
| | - Melissa Hamilton
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Jenna M Collins
- Evidera, 500 Totten Pond Road, Fifth Floor, Waltham, MA 02451, USA
| | - Dennis Earle
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Ying Zhang
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| | | | - Leonel Hernandez-Aya
- Washington University, Division of Oncology, 660 South Euclid Avenue, St Louis, MO 63110, USA
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Pinto CA, Liu X, Li X, Scherrer E, Kalabis M. Treatment and overall survival among anti-PD-1-exposed advanced melanoma patients with evidence of disease progression. Immunotherapy 2021; 14:201-214. [PMID: 34870445 DOI: 10.2217/imt-2021-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Little is known regarding treatment patterns and overall survival (OS) for patients with advanced melanoma who progress after anti-PD-1 exposure. Methods: The Kaplan-Meier method was used to evaluate OS from electronic health records for patients with advanced melanoma who progressed on anti-PD-1 therapy and received subsequent therapy. Descriptive statistics were used to summarize treatment. Results: A total of 304 patients who progressed after anti-PD-1 therapy received subsequent therapy: 50% immunotherapy, 36% BRAF and/or MEK inhibitors, 14% other therapies. Median OS was 7.2 months (95% CI: 6.4-8.8), with an association (p < 0.01) with best response to baseline anti-PD-1 therapy and further associations with Eastern Co-operative Oncology Group (ECOG) performance status ≤1 (p < 0.001 compared with ECOG ≥2), normal LDH (p < 0.001 compared with elevated levels) and treatment with BRAF and/or MEK inhibitors (p = 0.02 compared with other treatment). There was an association (p < 0.01) of survival with best response to baseline anti-PD-1 therapy. Conclusions: OS for advanced melanoma patients who progress on anti-PD-1 therapy is suboptimal, which highlights the need for further research to develop new medications and optimize treatment strategies.
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Affiliation(s)
- Cathy A Pinto
- Epidemiology, Biostatistics & Research Decision Sciences, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Xinyue Liu
- Epidemiology, Biostatistics & Research Decision Sciences, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Xiaoyun Li
- Biostatistics, Biostatistics & Research Decision Sciences, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Emilie Scherrer
- Center for Observational & Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Mizuho Kalabis
- Clinical Research, Merck & Co., Inc., Kenilworth, NJ, USA
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Sheinson DM, Wong WB, Meyer CS, Stergiopoulos S, Lofgren KT, Flores C, Adams DV, Fleury ME. Trends in Use of Next-Generation Sequencing in Patients With Solid Tumors by Race and Ethnicity After Implementation of the Medicare National Coverage Determination. JAMA Netw Open 2021; 4:e2138219. [PMID: 34882180 PMCID: PMC8662372 DOI: 10.1001/jamanetworkopen.2021.38219] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
Importance In March 2018, Medicare issued a national coverage determination (NCD) for next-generation sequencing (NGS) to facilitate access to NGS testing among Medicare beneficiaries. It is unknown whether the NCD affected health equity issues for Medicare beneficiaries and the overall population. Objective To examine the association between the Medicare NCD and NGS use by insurance types and race and ethnicity. Design, Setting, and Participants A retrospective cohort analysis was conducted using electronic health record data derived from a real-world database. Data originated from approximately 280 cancer clinics (approximately 800 sites of care) in the US. Patients with advanced non-small cell lung cancer (aNSCLC), metastatic colorectal cancer (mCRC), metastatic breast cancer (mBC), or advanced melanoma diagnosed from January 1, 2011, through March 31, 2020, were included. Exposure Pre- vs post-NCD period. Main Outcomes and Measures Patients were classified by insurance type and race and ethnicity to examine patterns in NGS testing less than or equal to 60 days after diagnosis. Difference-in-differences models examined changes in average NGS testing in the pre- and post-NCD periods by race and ethnicity, and interrupted time-series analysis examined whether trends over time varied by insurance type and race and ethnicity. Results Among 92 687 patients with aNSCLC, mCRC, mBC, or advanced melanoma, mean (SD) age was 66.6 (11.2) years, 51 582 (55.7%) were women, and 63 864 (68.9%) were Medicare beneficiaries. The largest racial and ethnic categories according to the database used and further classification were Black or African American (8605 [9.3%]) and non-Hispanic White (59 806 [64.5%]). Compared with Medicare beneficiaries, changes in pre- to post-NCD NGS testing trends were similar in commercially insured patients (odds ratio [OR], 1.03; 95% CI, 0.98-1.08; P = .25). Pre- to post-NCD NGS testing trends increased at a slower rate among patients in assistance programs (OR, 0.93; 95% CI, 0.87-0.99; P = .03) compared with Medicare beneficiaries. The rate of increase for patients receiving Medicaid was not statistically significantly different compared with those receiving Medicare (OR, 0.92; 95% CI, 0.84-1.01; P = .07). The NCD was not associated with statistically significant changes in NGS use trends by racial and ethnic groups within Medicare beneficiaries alone or across all insurance types. Compared with non-Hispanic White individuals, increases in average NGS use from the pre-NCD to post-NCD period were 14% lower (OR, 0.86; 95% CI, 0.74-0.99; P = .04) among African American and 23% lower (OR, 0.77; 95% CI, 0.62-0.96; P = .02) among Hispanic/Latino individuals; increases among Asian individuals and those with other races and ethnicities were similar. Conclusions and Relevance The findings of this study suggest that expansion of Medicare-covered benefits may not occur equally across insurance types, thereby further widening or maintaining disparities in NGS testing. Additional efforts beyond coverage policies are needed to ensure equitable access to the benefits of precision medicine.
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Affiliation(s)
| | | | | | | | | | | | - Devon V. Adams
- American Cancer Society Cancer Action Network, Washington, DC
| | - Mark E. Fleury
- American Cancer Society Cancer Action Network, Washington, DC
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Skovlund PC, Vind Thaysen H, Schmidt H, Alsner J, Hjollund NH, Lomborg K, Nielsen BK. Effect of patient-reported outcomes as a dialogue-based tool in cancer consultations on patient self-management and health-related quality of life: a clinical, controlled trial. Acta Oncol 2021; 60:1668-1677. [PMID: 34403293 DOI: 10.1080/0284186x.2021.1962972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND With increased survival among patients with metastatic melanoma and limited time with health care providers, patients are expected to assume a more active role in managing their treatment and care. Activated patients have the knowledge, skills, and confidence to make effective solutions to self-manage health. The use of patient-reported outcomes (PRO) could have the potential to enhance patient activation. However, PRO-based interventions that facilitate an activation in patients with metastatic melanoma are lacking and warranted. MATERIAL AND METHODS In this prospective non-randomized controlled, clinical trial, patients with metastatic melanoma were assigned to either the intervention (systematic feedback and discussion of PRO during consultation) given at one hospital or the control group (treatment as usual) if they received treatment from two other hospitals in Denmark. The primary outcome was the patient activation measure (PAM), which reflects self-management. Secondary outcomes were health-related quality of life (HRQoL), self-efficacy, and Patient-Physician interaction. Outcomes were measured at baseline, and after 3, 6, and 12 months. The analysis of the effect from baseline to 12 months employed mixed-effects modeling. RESULTS Between 2017 and 2019, patients were allocated to either the intervention group (n = 137) or the control group (n = 142). We found no significant difference in the course of patient activation between the two groups over time. The course of HRQoL was statistically significantly improved by the intervention compared to the control group. Especially, females in the intervention group performed better than males. The other secondary outcomes were not improved by the intervention. CONCLUSION The intervention did not improve knowledge, skills, and confidence for self-management for patients with metastatic melanoma. Neither did it improve coping self-efficacy nor perceived efficacy in Patient-Physician interaction. However, the results suggest that the intervention can have a significant impact on HRQoL and in particular social and emotional well-being among the females.
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Affiliation(s)
- Pernille Christiansen Skovlund
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
| | - Henriette Vind Thaysen
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jan Alsner
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex – Center for Patient-reported Outcomes, Hospital Unit West Jutland, Herning, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Berit Kjærside Nielsen
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Aarhus N, Denmark
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Mariotto AB, Zhang F, Buckman DW, Miller D, Cho H, Feuer EJ. Characterizing Trends in Cancer Patients' Survival Using the JPSurv Software. Cancer Epidemiol Biomarkers Prev 2021; 30:2001-2009. [PMID: 34404682 PMCID: PMC9662894 DOI: 10.1158/1055-9965.epi-21-0423] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/14/2021] [Accepted: 08/04/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Improvements in cancer survival are usually assessed by comparing survival in grouped years of diagnosis. To enhance analyses of survival trends, we present the joinpoint survival model webtool (JPSurv) that analyzes survival data by single year of diagnosis and estimates changes in survival trends and year-over-year trend measures. METHODS We apply JPSurv to relative survival data for individuals diagnosed with female breast cancer, melanoma cancer, non-Hodgkin lymphoma (NHL), and chronic myeloid leukemia (CML) between 1975 and 2015 in the Surveillance, Epidemiology, and End Results Program. We estimate the number and location of joinpoints and the trend measures and provide interpretation. RESULTS In general, relative survival has substantially improved at least since the mid-1990s for all cancer sites. The largest improvements in 5-year relative survival were observed for distant-stage melanoma after 2009, which increased by almost 3 survival percentage points for each subsequent year of diagnosis, followed by CML in 1995-2010, and NHL in 1995-2003. The modeling also showed that for patients diagnosed with CML after 1995 (compared with before), there was a greater decrease in the probability of dying of the disease in the 4th and 5th years after diagnosis compared with the initial years since diagnosis. CONCLUSIONS The greatest increases in trends for distant melanoma, NHL, and CML coincided with the introduction of novel treatments, demonstrating the value of JPSurv for estimating and interpreting cancer survival trends. IMPACT The JPSurv webtool provides a suite of estimates for analyzing trends in cancer survival that complement traditional descriptive survival analyses.
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Affiliation(s)
- Angela B. Mariotto
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland.,Corresponding Author: Angela B. Mariotto, Division of Cancer Control and Population Sciences, NCI, 9609 Medical Center Drive, Bethesda, MD 20892-9764. Phone: 240-276-6698; E-mail:
| | - Fanni Zhang
- Information Management Services Inc., Calverton, Maryland
| | | | - Daniel Miller
- Information Management Services Inc., Calverton, Maryland
| | - Hyunsoon Cho
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of South Korea.,Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Gyeonggi-do, Republic of South Korea
| | - Eric J. Feuer
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
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van Boemmel-Wegmann S, Brown JD, Diaby V, Huo J, Silver N, Park H. Health Care Utilization and Costs Associated With Systemic First-Line Metastatic Melanoma Therapies in the United States. JCO Oncol Pract 2021; 18:e163-e174. [PMID: 34228489 DOI: 10.1200/op.21.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE US Food and Drug Administration approvals of immune checkpoint inhibitors and targeted therapies revolutionized the treatment of metastatic melanoma. Our aim was to assess health care resource utilization and costs for patients with metastatic melanoma treated with systemic therapies in first line between January 2012 and December 2017. METHODS We conducted a retrospective cohort study of patients with metastatic melanoma using MarketScan data. We included patients diagnosed with melanoma and secondary malignant neoplasm who used pembrolizumab, nivolumab, ipilimumab, ipilimumab plus nivolumab, BRAF-inhibitor (BRAF-i) plus MEK inhibitor (MEK-i), BRAF-i or MEK-i monotherapy, or chemotherapy in first line. We compared health care utilization and costs per patient per month (PPPM) using two-part and generalized linear models. RESULTS We identified 1,870 patients, including 185 pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab plus ipilimumab, 214 BRAF-i plus MEK-i, 240 BRAF-i or MEK-i monotherapy, and 254 chemotherapy users. Highest PPPM rates of hospitalizations, emergency room visits, and outpatient visits were observed in patients with ipilimumab plus nivolumab therapy (adjusted difference v pembrolizumab [aDiff], 0.18, 0.12, and 0.88, respectively; all P < .001). Ipilimumab monotherapy users (aDiff, 0.07 and 0.93; all P < .001) and chemotherapy users (aDiff, 0.10 and 2.63; all P < .001) showed higher PPPM rates of hospitalizations and outpatient visits compared with pembrolizumab users, respectively. Utilization rates in nivolumab, BRAF-i plus MEK-i, and BRAF-i or MEK-i groups were similar to the pembrolizumab group. Highest PPPM total costs and drug-related costs were observed in the ipilimumab group ($80,139 US dollars [USD] and $70,051 USD; all P < .001), followed by the ipilimumab plus nivolumab ($71,689 USD and $56,217 USD; all P < .001) and the BRAF-i plus MEK-i group ($31,184 USD and $19,648 USD; all P < .001). PPPM costs in the nivolumab group were similar to the pembrolizumab group. CONCLUSION Significant differences in health care resource utilization and costs were found across first-line metastatic melanoma regimens. Utilization rates were highest in patients using ipilimumab-containing therapies. High drug costs constituted a major fraction of total PPPM health care costs.
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Affiliation(s)
- Sascha van Boemmel-Wegmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Natalie Silver
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
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Poizeau F, Kerbrat S, Happe A, Rault C, Drezen E, Balusson F, Tuppin P, Guillot B, Thuret A, Boussemart L, Dinulescu M, Pracht M, Lesimple T, Droitcourt C, Oger E, Dupuy A. Patients with Metastatic Melanoma Receiving Anticancer Drugs: Changes in Overall Survival, 2010–2017. J Invest Dermatol 2021; 141:830-839.e3. [DOI: 10.1016/j.jid.2020.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022]
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11
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma: A population-based study. Medicine (Baltimore) 2021; 100:e24782. [PMID: 33607829 PMCID: PMC7899862 DOI: 10.1097/md.0000000000024782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
Improvement in overall survival by immune checkpoint inhibitors (ICI) treatment in clinical trials encourages their use for late-stage melanoma. However, in the real-world, heterogeneity of population, such as older patients with multimorbidity, may lead to a slower diffusion of ICIs. The objective of this study was to examine the association of multimorbidity and other factors to ICI use among older patients with late-stage melanoma using real world data.A retrospective cohort study design with a 12-month baseline and follow-up period was adopted with data from the linked Surveillance, Epidemiology, and End Results cancer registry/Medicare database. Older patients (>65 years) with late-stage (stage III/IV) melanoma diagnosed between 2012 and 2015 were categorized as with or without multimorbidity (presence of 2 or more chronic conditions) and ICI use was identified in the post-index period. Chi-square tests and logistic regression were used to evaluate factors associated with ICI use.In the study cohort, 85% had multimorbidity, 18% received any treatment (chemotherapy, radiation, and/or ICI), and 6% received ICI. Only 5.5% of older patients with multimorbidity and 6% without multimorbidity received ICIs. Younger age, presence of social support, lower economic status, residence in northeastern regions, and recent year of diagnosis were significantly associated with ICI use; however, multimorbidity, sex, and race were not associated with ICI use.In the real-world clinical practice, only 1 in 18 older adults with late stage melanoma received ICI, suggesting slow pace of diffusion of innovation. However, multimorbidity was not a barrier to ICI use.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research and Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Kimberly M. Kelly
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Virginia G. Scott
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Usha Sambamoorthi
- Professor and Associate Dean of Health Outcomes Research, Department of Pharmacotherapy University of North Texas Health Sciences Center College of Pharmacy
- Vashisht Professor, Health Disparities, Health Education, Awareness & Research in Disparities Scholar, Texas Center for Health Disparities, HSC, Fort Worth TX
- Professor Emeritus, West Virginia University School of Pharmacy, Pharmaceutical Systems and Policy, Morgantown WV
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12
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Spillane S, Baxi S, Torres AZ, Lenis D, Freedman AN, Mariotto AB, Sharon E. Organ Dysfunction in Patients with Advanced Melanoma Treated with Immune Checkpoint Inhibitors. Oncologist 2020; 25:e1753-e1762. [PMID: 33094874 PMCID: PMC7648349 DOI: 10.1634/theoncologist.2020-0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Real-world data enables evaluation of immune checkpoint inhibitor (ICI) use in advanced melanoma management. We examined characteristics and outcomes of ICI-treated patients with advanced melanoma and organ dysfunction (baseline and emergent). MATERIALS AND METHODS This retrospective observational study used electronic health records derived from a nationwide data set to examine advanced melanoma patients treated with first-line ICIs (2011-2018). Clinical characteristics, real-world time to treatment discontinuation (rwTTD), and overall survival (OS) were analyzed for patients with normal organ function and those with organ dysfunction prior to ICI initiation. Patients with emergent dysfunction in the 90 days following ICI initiation were identified, and potentially associated characteristics were explored. RESULTS Of 2,407 patients included, 1,884 and 1,717 had evaluable renal and hepatic laboratory values, respectively. Patients with baseline renal dysfunction (2.4%) were older and more frequently male, and less frequently treated with ICI combinations, than patients with normal renal function. Patients with baseline hepatic dysfunction (2.8%) were similar to patients with normal hepatic function regarding demographics and treatments received. Patients with baseline organ dysfunction displayed shorter rwTTD and OS. Among patients with normal baseline organ function, 4.6% and 7.4% developed renal and hepatic dysfunction within 90 days of ICI initiation, respectively; this was associated with combination ICI treatment. CONCLUSION Patients with advanced melanoma and baseline organ dysfunction frequently receive ICI treatment but have poorer clinical outcomes than patients with normal organ function. Among patients with normal renal and hepatic function at ICI initiation, emergent organ dysfunction rates in this real-world cohort are similar to those reported in clinical trials. IMPLICATIONS FOR PRACTICE Real-world data provide an opportunity to understand treatment patterns, toxicity, and clinical outcomes among patients treated outside of clinical trials. This study confirms that patients with advanced melanoma and baseline renal or hepatic dysfunction are being treated with ICI therapy more frequently as monotherapy than in combination therapy. For those real-world patients with normal baseline organ function, emergent renal and hepatic dysfunction are both more common in patients treated with combination versus ICI monotherapy.
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Affiliation(s)
- Susan Spillane
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteBethesdaMarylandUSA
| | | | | | | | - Andrew N. Freedman
- Division of Cancer Control and Population Sciences, National Cancer InstituteBethesdaMarylandUSA
| | - Angela B. Mariotto
- Division of Cancer Control and Population Sciences, National Cancer InstituteBethesdaMarylandUSA
| | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer InstituteBethesdaMarylandUSA
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13
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Gogebakan KC, Berry EG, Geller AC, Sonmez K, Leachman SA, Etzioni R. Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach. Cancer Epidemiol Biomarkers Prev 2020; 29:2599-2607. [PMID: 32958498 DOI: 10.1158/1055-9965.epi-20-0881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Benefit-harm tradeoffs of melanoma screening depend on disease risk and treatment efficacy. We developed a model to project outcomes of screening for melanoma in populations with different risks under historic and novel systemic treatments. METHODS Computer simulation model of a screening program with specified impact on overall and advanced-stage incidence. Inputs included meta-analyses of treatment trials, cancer registry data, and a melanoma risk prediction study RESULTS: Assuming 50% reduction in advanced stage under screening, the model projected 59 and 38 lives saved per 100,000 men under historic and novel treatments, respectively. With 10% increase in stage I, the model projects 2.9 and 4.7 overdiagnosed cases per life saved and number needed to be screened (NNS) equal to 1695 and 2632 under historical and novel treatments. When screening was performed only for the 20% of individuals with highest predicted risk, 34 and 22 lives per 100,000 were saved under historic and novel treatments. Similar results were obtained for women, but lives saved were lower. CONCLUSIONS Melanoma early detection programs must shift a substantial fraction of cases from advanced to localized stage to be sustainable. Advances in systemic therapies for melanoma might noticeably reduce benefits of screening, but restricting screening to individuals at highest risk will likely reduce intervention efforts and harms while preserving >50% of the benefit of nontargeted screening. IMPACT Our accessible modeling framework will help to guide population melanoma screening programs in an era of novel treatments for advanced disease.
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Affiliation(s)
- Kemal Caglar Gogebakan
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Alan C Geller
- Division of Public Health Practice, Harvard School of Public Health, Boston, Massachusetts
| | - Kemal Sonmez
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Department of Statistics, University of Washington, Seattle, Washington
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Machado MADÁ, de Moura CS, Chan K, Curtis JR, Hudson M, Abrahamowicz M, Jamal R, Pilote L, Bernatsky S. Real-world analyses of therapy discontinuation of checkpoint inhibitors in metastatic melanoma patients. Sci Rep 2020; 10:14607. [PMID: 32884119 PMCID: PMC7471311 DOI: 10.1038/s41598-020-71788-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/22/2020] [Indexed: 11/21/2022] Open
Abstract
The 'real-world' patient population of metastatic melanoma is not fully represented in clinical trials investigating checkpoint inhibitors. We described therapy discontinuation in an unselected population-based cohort of adults with metastatic melanoma who started therapy with pembrolizumab, nivolumab, or nivolumab/ipilimumab from January 2015 to August 2017. Therapy discontinuation was defined as a gap between doses beyond 120 days, and/or initiation of another cancer therapy. We estimated drug-specific rate ratios for therapy discontinuation adjusted for age, sex, comorbidities, health care use, and past cancer therapies. We included 876 metastatic melanoma patients initiating pembrolizumab (44.3%), nivolumab/ipilimumab (31.2%), and nivolumab (24.5%). At 12 months of follow-up, the probabilities of therapy discontinuation were 49.9% (95% confidence interval, CI 43.6-56.5) for pembrolizumab, 58.8% (95% CI 50.5-67.3) for nivolumab, and 59.2% (95% CI 51.7-66.8) for nivolumab/ipilimumab. Stratified analyses based on prior cancer therapy, brain metastases at baseline, and sex showed similar trends. In multivariable analyses, compared with pembrolizumab, patients starting nivolumab (rate ratio 1.38, 95% CI 1.08-1.77) or nivolumab/ipilimumab (rate ratio 1.30, 95% CI 1.02-1.65) were more likely to discontinue therapy. Our findings indicate frequent discontinuations of checkpoint inhibitors at one year. The lower discontinuation associated with pembrolizumab should be confirmed in further studies.
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Affiliation(s)
| | - Cristiano Soares de Moura
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Kelvin Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jeffrey R Curtis
- Department of Medicine, University of Alabama At Birmingham, Birmingham, USA
| | - Marie Hudson
- Jewish General Hospital and Lady Davis Research Institute for Medical Research, Montreal, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Rahima Jamal
- Centre Hospitalier de L'Université de Montréal, Centre de Recherche du CHUM, Université de Montréal, Montreal, Canada
| | - Louise Pilote
- Department of Medicine, McGill University, Montreal, Canada
| | - Sasha Bernatsky
- Department of Medicine, McGill University, Montreal, Canada.
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15
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Cowey CL, Boyd M, Aguilar KM, Beeks A, Krepler C, Scherrer E. An observational study of drug utilization and associated outcomes among adult patients diagnosed with BRAF-mutant advanced melanoma treated with first-line anti-PD-1 monotherapies or BRAF/MEK inhibitors in a community-based oncology setting. Cancer Med 2020; 9:7863-7878. [PMID: 32871054 PMCID: PMC7643646 DOI: 10.1002/cam4.3312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Anti‐PD‐1 monotherapies (aPD‐1) and BRAF/MEK inhibitors (BRAF/MEKi) changed the BRAF‐mutant advanced melanoma treatment landscape. This study aimed to improve the understanding of real‐world treatment patterns and optimal treatment sequence. Methods This was a retrospective study of BRAF‐mutant advanced melanoma patients who initiated 1L aPD‐1 or BRAF/MEKi in the US Oncology Network between 1 January 2014 and 31 December 2017, followed through 31 December 2018. Patient and treatment characteristics were assessed descriptively, with Kaplan‐Meier methods used for time‐to‐event endpoints. As the primary analysis, overall survival (OS) and physician‐assessed progression‐free survival (rwPFS) were evaluated with Cox proportional hazard regression models and propensity score matching (n = 49). Results A total of 224 patients were included (median age 61 years, 62.9% male, 89.7% white): 36.2% received aPD‐1 and 63.8% BRAF/MEKi. Median OS and rwPFS were longer among aPD‐1 vs BRAF/MEKi patients (OS: not reached vs 13.9 months, log‐rank P = .0169; rwPFS: 7.6 vs 6.5 months, log‐rank P = .0144). Receipt of aPD‐1 was associated with improved OS (HR = 0.602 vs BRAF/MEKi [95%CI 0.382‐0.949]; P = .0287). Among patients without an event within 6 months of 1L initiation, receipt of aPD‐1 was associated with a decreased risk of progression or death from 6 months onwards (HR = 0.228 [95%CI 0.106‐0.493]; P = .0002). This association was not observed among patients within 6 months of 1L initiation (HR = 1.146; 95% CI 0.755‐1.738). Results from the propensity score‐matched pairs were consistent with these trends. Conclusion These results suggest a clinical benefit of 1L aPD‐1 compared to BRAF/MEKi after 6 months of treatment for BRAF‐mutant advanced melanoma. Future research should explore factors associated with early progression and their relationship with clinical outcomes.
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Affiliation(s)
- Charles L Cowey
- Texas Oncology Baylor Charles A Sammons Cancer Center, Dallas, TX, USA.,McKesson Life Sciences, The Woodlands, TX, USA
| | - Marley Boyd
- McKesson Life Sciences, The Woodlands, TX, USA
| | | | - April Beeks
- McKesson Life Sciences, The Woodlands, TX, USA
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16
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Xue D, Cheng P, Jiang J, Ren Y, Wu D, Chen W. Systemic Analysis of the Prognosis-Related RNA Alternative Splicing Signals in Melanoma. Med Sci Monit 2020; 26:e921133. [PMID: 32199022 PMCID: PMC7111138 DOI: 10.12659/msm.921133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/13/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Alternative splicing (AS), the mechanism underlying the occurrence of protein diversity, may result in cancer genesis and development when it becomes out of control, as suggested by a growing number of studies. However, systemically analyze of AS events at the genome-wide level for skin cutaneous melanoma (SKCM) is still in a preliminary phase. This study aimed to systemically analyze the bioinformatics of the AS events at a genome-wide level using The Cancer Genome Atlas (TCGA) SKCM data. MATERIAL AND METHODS The SpliceSeq tool was used to analyze the AS profiles for SKCM clinical specimens from the TCGA database. The association between AS events and overall survival was analyzed by Cox regression analysis. AS event intersections and a gene interaction network were established by UpSet plot. A multivariate survival model was used to establish a feature genes prognosis model. RESULTS A total of 103 SKCM patients with full clinical parameters available were included in this study. We established an AS network that investigated the relationship between AS events and clinical prognosis information. Furthermore, 4 underlying feature genes of SKCM (MCF2L, HARS, TFR2, and RALGPS1) were found in the AS network. We performed function analysis as well as correlation analysis of AS events with gene expression. Using the multivariate survival model, we further confirmed the 4 genes that impacted the classifying SKCM prognosis at the level of AS events as well as gene expression, especially in wild-type SKCM. CONCLUSIONS AS events could be ideal indicators for SKCM prognosis. The key feature gene MCF2L played an important role in wild-type SKCM.
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Affiliation(s)
- Dan Xue
- Department of Plastic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Pu Cheng
- Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Jinxin Jiang
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Yunqing Ren
- Department of Dermatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Dang Wu
- Department of Radiation Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Wuzhen Chen
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
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17
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Shah S, Raskin L, Cohan D, Hamid O, Freeman ML. Treatment patterns of melanoma by BRAF mutation status in the USA from 2011 to 2017: a retrospective cohort study. Melanoma Manag 2019; 6:MMT31. [PMID: 31871620 PMCID: PMC6920746 DOI: 10.2217/mmt-2019-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022] Open
Abstract
AIM To describe treatment changes from 2011 to 2017 and demographic/clinical characteristics of patients with advanced melanoma who received systemic therapy by BRAF status. PATIENTS & METHODS Treatment patterns were evaluated in adults from the Oncology Services Comprehensive Electronic Records database who received antimelanoma systemic therapy. RESULTS Checkpoint inhibitors were prevailingly prescribed (66%); usage increased from 2011 (21%) to 2017 (84%). BRAF/MEK inhibitors were the second most common (21%); usage increased from 2011 (6%) to 2012 (18%) and stabilized until 2017 (22%). BRAF/MEK inhibitors (65%) and checkpoint inhibitors (57%) were predominantly used for BRAFMut melanoma. CONCLUSION Overall, checkpoint inhibitors have supplanted other therapies for advanced melanoma. Treatment shifts have occurred for BRAFMut melanoma, notably increased use of checkpoint inhibitors and BRAF/MEK combinations compared with monotherapies.
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Affiliation(s)
- Shweta Shah
- Global Health Economics, Amgen Inc., Thousand Oaks, CA, USA
| | - Leon Raskin
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - David Cohan
- Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA
| | - Omid Hamid
- The Angeles Clinic & Research Institute, Los Angeles, CA, USA
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18
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Meng W, Ou W, Chandwani S, Chen X, Black W, Cai Z. Temporal phenotyping by mining healthcare data to derive lines of therapy for cancer. J Biomed Inform 2019; 100:103335. [PMID: 31689549 DOI: 10.1016/j.jbi.2019.103335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 01/29/2023]
Abstract
Lines of therapy (LOT) derived from real-world healthcare data not only depict real-world cancer treatment sequences, but also help define patient phenotypes along the course of disease progression and therapeutic interventions. The sequence of prescribed anticancer therapies can be defined as temporal phenotyping resulting from changes in morphological (tumor staging), biochemical (biomarker testing), physiological (disease progression), and behavioral (physician prescribing and patient adherence) parameters. We introduce a novel methodology that is a two-part approach: 1) create an algorithm to derive patient-level LOT and 2) aggregate LOT information via clustering to derive temporal phenotypes, in conjunction with visualization techniques, within a large insurance claims dataset. We demonstrated the methodology using two examples: metastatic non-small cell lung cancer and metastatic melanoma. First, we generated a longitudinal patient cohort for each cancer type and applied a set of rules to derive patient-level LOT. Then the LOT algorithm outputs for each cancer type were visualized using Sankey plots and K-means clusters based on durations of LOT and of gaps in therapy between LOT. We found differential distribution of temporal phenotypes across clusters. Our approach to identify temporal patient phenotypes can increase the quality and utility of analyses conducted using claims datasets, with the potential for application to multiple oncology disease areas across diverse healthcare data sources. The understanding of LOT as defining patients' temporal phenotypes can contribute to continuous health learning of disease progression and its interaction with different treatment pathways; in addition, this understanding can provide new insights that can be applied by tailoring treatment sequences for the patient phenotypes who will benefit.
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Affiliation(s)
- Weilin Meng
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA.
| | - Wanmei Ou
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Sheenu Chandwani
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Xin Chen
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Wynona Black
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Zhaohui Cai
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ 07033, USA
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Tsutsumida A, Fukushima S, Yokota K, Yoshikawa S, Yamasaki O, Tanemura A, Okuyama R, Uhara H, Muto Y, Miyashita A, Akiyama M, Kaji T, Koga H, Kato J, Katayama T, Itakura E, Yamazaki N, Kiyohara Y. Japanese real‐world study of sequential nivolumab and ipilimumab treament in melanoma. J Dermatol 2019; 46:947-955. [DOI: 10.1111/1346-8138.15073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/08/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Arata Tsutsumida
- Department of Dermatologic OncologyNational Cancer Center Hospital Tokyo Japan
- Department of Dermato-OncologyCancer Institute Hospital of JFCR Tokyo Japan
| | - Satoshi Fukushima
- Department of Dermatology and Plastic SurgeryFaculty of Life SciencesKumamoto University Kumamoto Japan
| | - Kenji Yokota
- Department of DermatologyNagoya University Graduate School of Medicine Aichi Japan
| | | | - Osamu Yamasaki
- Department of DermatologyOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Atsushi Tanemura
- Department of DermatologyCourse of Integrated MedicineGraduate School of MedicineOsaka University Osaka Japan
| | - Ryuhei Okuyama
- Department of DermatologyShinshu University School of Medicine Nagano Japan
| | - Hisashi Uhara
- Department of DermatologySapporo Medical University Hokkaido Japan
| | - Yusuke Muto
- Department of Dermatologic OncologyNational Cancer Center Hospital Tokyo Japan
| | - Azusa Miyashita
- Department of Dermatology and Plastic SurgeryFaculty of Life SciencesKumamoto University Kumamoto Japan
| | - Masashi Akiyama
- Department of DermatologyNagoya University Graduate School of Medicine Aichi Japan
| | - Tatsuya Kaji
- Department of DermatologyOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Hiroshi Koga
- Department of DermatologyShinshu University School of Medicine Nagano Japan
| | - Junji Kato
- Department of DermatologySapporo Medical University Hokkaido Japan
| | | | | | - Naoya Yamazaki
- Department of Dermatologic OncologyNational Cancer Center Hospital Tokyo Japan
| | - Yoshio Kiyohara
- Department of DermatologyShizuoka Cancer Center Shizuoka Japan
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20
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Liu X, Zhong D. [Research Progress of Immune Checkpoint Inhibitor Therapy for BRAF Mutation
in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:583-589. [PMID: 31526463 PMCID: PMC6754571 DOI: 10.3779/j.issn.1009-3419.2019.09.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
在非小细胞肺癌(non-small cell lung cancer, NSCLC)患者中,约2%-4%有BRAF基因突变,该型肿瘤恶性程度高、化疗有效率低、预后差。尽管BRAF抑制剂及MEK抑制剂联合治疗在BRAF V600E突变的晚期NSCLC患者中成效显著,已被写入美国国家综合癌症网络(National Comprehensive Cancer Network, NCCN)指南,但两药联合副作用发生率高,耐药之后尚无有效治疗策略,且针对非V600E突变患者仍缺乏靶向治疗方案。本文将针对BRAF突变型NSCLC免疫标志物表达情况以及免疫检查点抑制剂(immune checkpoint inhibitor, ICI)疗效相关研究做一综述,为延长患者生存提供更多选择方案。
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Affiliation(s)
- Xia Liu
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
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21
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Fox J, Janda M, Bennett F, Langbecker D. An outreach telephone program for advanced melanoma supportive care: Acceptability and feasibility. Eur J Oncol Nurs 2019; 42:110-115. [PMID: 31493669 DOI: 10.1016/j.ejon.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE People with advanced melanoma face an uncertain trajectory as new treatments now have the potential to provide longer-term survival for some. However, the disease course is variable and unpredictable, with many expressing a need for better supportive care. This study aimed to investigate the acceptability and feasibility of extending an existing melanoma-specific self-referral or 'passive' telephone consultation support service to an 'active' outreach call to offer a supportive care program tailored to the needs of the patient. METHOD Participants were enrolled by their oncology nurse into a single group pre-post intervention study. Participants received an outreach telephone call focused on knowledge and skill development. Participants completed questionnaires at baseline and four weeks post-intervention. Post-intervention interviews with patients and involved staff were used to explore acceptability and feasibility of the outreach service call. RESULTS Of 18 participants approached, 15 enrolled and 14 received the intervention. Staff time required for intervention delivery provided evidence for feasibility. Participants perceived the intervention as acceptable, and beneficial. In interviews, having someone with melanoma-specific knowledge to talk with was a key benefit of the outreach call program. Many participants expressed that they would have wished to receive the outreach call at an earlier stage, for example at the time of recurrence of/progression to advanced melanoma. CONCLUSIONS Extending an existing self-referral support service model to use a more 'active' outreach approach is acceptable and feasible. The next step in the evaluation process for this intervention is a randomised controlled trial to determine effectiveness and cost-effectiveness.
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Affiliation(s)
- Jennifer Fox
- School of Nursing, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld, 4075, Australia.
| | - Monika Janda
- Centre for Health Service Research, Faculty of Medicine, Institute of Health and Biomedical Innovation, The University of Queensland, Woolloongabba, Qld, 4102, Australia; School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
| | - Fiona Bennett
- Melanoma Patients Australia, Mater Foundation, 620 Stanley Street, Woolloongabba, Brisbane, 4102, Australia.
| | - Danette Langbecker
- Centre for Online Health - Centre for Health Services Research, The University of Queensland, Ground floor, Building 33, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Qld, 4102, Australia.
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22
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Klink AJ, Chmielowski B, Feinberg B, Ahsan S, Nero D, Liu FX. Health Care Resource Utilization and Costs in First-Line Treatments for Patients with Metastatic Melanoma in the United States. J Manag Care Spec Pharm 2019; 25:869-877. [PMID: 30945965 PMCID: PMC10397699 DOI: 10.18553/jmcp.2019.18442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The treatment landscape for patients with metastatic melanoma has changed dramatically with the introduction of novel therapies, such as targeted therapies and immunotherapies, in recent years. Health care resource utilization (HCRU) and cost data are needed to further evaluate these treatments in a value-based health care system. OBJECTIVE To examine HCRU and total cost of care among U.S. metastatic melanoma patients treated with first-line systemic therapies, including immunotherapies, targeted therapies, and chemotherapy. METHODS A retrospective observational study was conducted using a U.S. claims database. Adults with ≥ 2 claims for melanoma and ≥ 1 claim for metastasis between January 1, 2012, and June 30, 2017, were identified. Patients had pharmacy and medical enrollment ≥ 6 months before and ≥ 3 months following first-line treatment start. Per patient per month (PPPM) HCRU and costs were calculated by first-line treatment drug class: PD-1 inhibitors, CTLA-4 inhibitors, CTLA-4 + PD-1 combination, BRAF monotherapy, BRAF + MEK combination, and chemotherapy. Adjusted odds ratios (ORs) for HCRU were estimated by logistic regressions and adjusted costs were estimated by generalized linear models using log-link with gamma distribution to control for differences in patient characteristics across groups. RESULTS Among 1,599 metastatic melanoma patients (PD-1, n = 255; CTLA-4, n = 555; CTLA-4 + PD-1, n = 88; BRAF, n = 210; BRAF + MEK, n=102; chemotherapy=389), mean age ranged from 59-68 years, and the majority were male (62%). Any hospitalization during first-line treatment was less frequent among PD-1-treated patients (25.9%) compared with 34.7%-45.5% of all other groups (all P < 0.05). PPPM hospitalizations were lowest in PD-1 (0.06) compared with 0.09-0.16 across all other groups (all P < 0.05), and PPPM emergency department (ED) visits were lowest in PD-1 (0.09) compared with 0.13-0.18 across all other groups (all P < 0.05), except for BRAF + MEK (0.14, P = 0.08). CTLA-4, CTLA-4 + PD-1, and BRAF + MEK had increased odds of hospitalization compared to PD-1 (adjusted ORs = 2.10, 2.35, 2.15, respectively; all P < 0.05). Total adjusted PPPM costs were significantly lower for PD-1 ($13,059) compared with CTLA-4 ($25,583), CTLA-4 + PD-1 ($31,310), and BRAF + MEK ($21,517) and higher compared to BRAF ($8,158) and chemotherapy ($6,361). CONCLUSIONS Hospitalizations and ED visits represent important HCRU for metastatic melanoma patients and were lowest among PD-1-treated patients compared with any other systemic therapies (except for ED visits when compared with BRAF + MEK). Total monthly costs varied substantially across first-line regimens and were significantly lower in PD-1-treated patients compared with patients treated with CTLA-4, CTLA-4 + PD-1, and BRAF + MEK. DISCLOSURES This study was funded by Merck Sharp & Dohme, a subsidiary of Merck & Co. Klink, Feinberg, and Nero are employees of Cardinal Health Specialty Solutions, which received funding from Merck to conduct this study. Chmielsowki is a consultant to Merck but received no funding for the development of this manuscript. Ahsan and Liu are employees of Merck. Chmielowski reports advisory board/speaker fees from Bristol-Myers Squibb, Merck, Genentech/Roche, Iovance Biotherapeutics, HUYA Bioscience International, Compugen, Array BioPharma, Regeneron, Biothera, Janssen, and Novartis. Ahsan has a patent (US20160008380A1) pending.
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Affiliation(s)
| | - Bartosz Chmielowski
- Division of Hematology-Medical Oncology, University of California, Los Angeles
| | | | | | - Damion Nero
- Cardinal Health Specialty Solutions, Columbus, Ohio
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23
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Cowey CL, Liu FX, Boyd M, Aguilar KM, Krepler C. Real-world treatment patterns and clinical outcomes among patients with advanced melanoma: A retrospective, community oncology-based cohort study (A STROBE-compliant article). Medicine (Baltimore) 2019; 98:e16328. [PMID: 31305421 PMCID: PMC6641721 DOI: 10.1097/md.0000000000016328] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Recently, the effectiveness of novel immune checkpoint inhibitors and BRAF-directed therapies has been demonstrated in advanced melanoma trial populations. Limited research, however, has evaluated the impact of these therapies in a real-world setting. The aim of this study was to evaluate treatment patterns and clinical outcomes among advanced melanoma patients treated with modern therapies within community oncology clinics. Adult patients with advanced melanoma who initiated treatment within the US Oncology Network between 1/1/14 and 12/31/16 were included. Data were sourced from electronic healthcare records. Patients were followed through 12/31/17. Descriptive analyses were performed to assess patient and treatment characteristics and Kaplan-Meier methods were used for time-to-event outcomes. In total, 484 patients met eligibility criteria (32.0% with brain metastasis, 12.6% with Eastern Cooperative Oncology Group performance status ≥2). In the first-line (1L) setting during the study period, 37.0% received anti-PD1 monotherapies, 26.4% ipilimumab monotherapy, 19.8% BRAF/MEK combination therapy, 6.4% BRAF or MEK monotherapy, 4.1% ipilimumab/nivolumab combination therapy and 6.2% other regimens. Differences in baseline demographic and clinical characteristics were observed across treatment groups. For the overall study population, the median (95% confidence interval) estimates for overall survival, time to next treatment and progression-free survival were 20.7 (16.0, 26.8), 5.8 (5.3, 6.5), and 4.9 (4.2, 5.7) months, respectively. The results of this study provide real-world insight into advanced melanoma treatment trends and clinical outcomes, including high utilization of immunotherapies and BRAF/MEK combination therapy. Future research can explore underlying differences in patient subpopulations and the sequence of therapies across lines of therapy.
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24
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Liu FX, Ou W, Diede SJ, Whitman ED. Real-world experience with pembrolizumab in patients with advanced melanoma: A large retrospective observational study. Medicine (Baltimore) 2019; 98:e16542. [PMID: 31348273 PMCID: PMC6709121 DOI: 10.1097/md.0000000000016542] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pembrolizumab has been approved in the United States for treating advanced melanoma for >4 years. We examined real-world pembrolizumab use and associated outcomes in US oncology clinical practices, including patients who would not be eligible for clinical trials.Flatiron Health longitudinal database was used to identify adult patients with advanced melanoma initiating ≥1 dose of pembrolizumab from September 4, 2014, through December 31, 2016, with follow-up through December 31, 2017. Patients in any clinical trial during the study period were excluded. Overall survival (OS) and time on treatment from pembrolizumab initiation were analyzed using the Kaplan-Meier (KM) method. Subgroup analyses were conducted to examine OS for several patient characteristics including Eastern Cooperative Oncology Group (ECOG) performance status >1, brain metastases, and corticosteroids before pembrolizumab initiation.Pembrolizumab was administered to 315 (59%), 152 (29%), and 65 (12%) patients as first-, second-, and third-line/later therapy. Median age at pembrolizumab initiation was 68 years (range, 18-84); most patients were male (66%) and white (94%). Of those with available data, 38% had BRAF-mutant melanoma, 21% had elevated lactate dehydrogenase (LDH) level, and 23% had ECOG >1. Overall, 18% had brain metastases, and 23% were prescribed corticosteroids <3 months before initiating pembrolizumab. Median study follow-up was 12.9 months (range, 0.03-39.6). Median OS was 21.8 months (95% confidence interval [CI] 16.8-29.1); KM 1-year and 2-year survival rates were 61% and 48%, respectively; and median time on pembrolizumab treatment was 4.9 months (95% CI 3.7-5.5). Median OS for first-line pembrolizumab was not reached, and for second-line and third-line/later was 13.9 and 12.5 months, respectively (log-rank P = .0095). Significantly better OS (all P ≤.0014, log-rank test) was evident for patients with ECOG performance status (PS) of 0 to 1 (vs >1), normal (vs elevated) LDH level, and no (vs yes) corticosteroid prescription <3 months before. No difference was recorded in OS by brain metastases (log-rank P = .22) or BRAF mutation status (log-rank P = .90).These findings support effectiveness of pembrolizumab in the real-world clinical setting and provide important insights into patient characteristics and outcomes associated with pembrolizumab therapy for a heterogeneous patient population with advanced melanoma, including patients who would not be eligible for clinical trials.
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Affiliation(s)
| | | | | | - Eric D. Whitman
- Atlantic Melanoma Center, Atlantic Health System Cancer Care, Morristown, NJ
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