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Ismail RK, Sikkes NO, Wouters MWJM, Hilarius DL, Pasmooij AMG, van den Eertwegh AJM, Aarts MJB, van den Berkmortel FWPJ, Boers-Sonderen MJ, de Groot JWB, Haanen JBAG, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Suijkerbuijk KPM, Ten Tije BJ, van der Veldt AAM, Vreugdenhil A, van Dartel M, de Boer A. Postapproval trials versus patient registries: comparability of advanced melanoma patients with brain metastases. Melanoma Res 2021; 31:58-66. [PMID: 33351553 PMCID: PMC7757745 DOI: 10.1097/cmr.0000000000000707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
Postapproval trials and patient registries have their pros and cons in the generation of postapproval data. No direct comparison between clinical outcomes of these data sources currently exists for advanced melanoma patients. We aimed to investigate whether a patient registry can complement or even replace postapproval trials. Postapproval single-arm clinical trial data from the Medicines Evaluation Board and real-world data from the Dutch Melanoma Treatment Registry were used. The study population consisted of advanced melanoma patients with brain metastases treated with targeted therapies (BRAF- or BRAF-MEK inhibitors) in the first line. A Cox hazard regression model and a propensity score matching (PSM) model were used to compare the two patient populations. Compared to patients treated in postapproval trials (n = 467), real-world patients (n = 602) had significantly higher age, higher ECOG performance status, more often ≥3 organ involvement and more symptomatic brain metastases. Lactate dehydrogenase levels were similar between both groups. The unadjusted median overall survival (mOS) in postapproval clinical trial patients was 8.7 (95% CI, 8.1-10.4) months compared to 7.2 (95% CI, 6.5-7.7) months (P < 0.01) in real-world patients. With the Cox hazard regression model, survival was adjusted for prognostic factors, which led to a statistically insignificant difference in mOS for trial and real-world patients of 8.7 (95% CI, 7.9-10.4) months compared to 7.3 (95% CI, 6.3-7.9) months, respectively. The PSM model resulted in 310 matched patients with similar survival (P = 0.9). Clinical outcomes of both data sources were similar. Registries could be a complementary data source to postapproval clinical trials to establish information on clinical outcomes in specific subpopulations.
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Affiliation(s)
- Rawa K Ismail
- Scientific Department, Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Heidelberglaan
- Medicines Evaluation Board, Graadt van Roggenweg, Utrecht
| | - Nienke O Sikkes
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Heidelberglaan
| | - Michel W J M Wouters
- Scientific Department, Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan, Amsterdam
| | | | - Anna M G Pasmooij
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan, Amsterdam
| | | | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Centre, P. Debyelaan, Maastricht
| | | | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid, Nijmegen
| | | | - John B A G Haanen
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan, Amsterdam
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, Hanzeplein, Groningen
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef, Leiden
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Koningsplein, Enschede
| | - Roos S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Henri Dunantweg, Leeuwarden
| | | | - Bert-Jan Ten Tije
- Department of Internal Medicine, Amphia Hospital, Molengracht, Breda
| | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology and Nuclear Medicine, Erasmus Medical Centre, 's-Gravendijkwal, Rotterdam
| | - Art Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, De Run, Eindhoven, The Netherlands
| | - Maaike van Dartel
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan, Amsterdam
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Heidelberglaan
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan, Amsterdam
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