Real-World Treatment Patterns of Advanced Melanoma in the United States
Author(s)
Matthew S. Block, MD, PhD1, Katrine L. Wallace, PhD2, Rene Marcotte, MS3, Vikram Uolligadla, MS4, Brian Caruso, MS5.
1Oncology, Mayo Clinic, Rochester, MN, USA, 2Replimune, Woburn, MA, USA, 3RCM Consulting, Attleboro, MA, USA, 4RCM Consulting, McKinney, TX, USA, 5RCM Consulting, San Diego, CA, USA.
1Oncology, Mayo Clinic, Rochester, MN, USA, 2Replimune, Woburn, MA, USA, 3RCM Consulting, Attleboro, MA, USA, 4RCM Consulting, McKinney, TX, USA, 5RCM Consulting, San Diego, CA, USA.
OBJECTIVES: Melanoma has a good prognosis if diagnosed at a localized stage. However, despite significant recent advances in therapy, treatments for patients with unresectable or metastatic melanoma are most often not curative. The objective of this study was to characterize real-world treatment patterns of advanced, unresectable melanoma patients who progress to second-line (2L) systemic treatment.
METHODS: Adults in a large administrative claims database between 1/2018-6/2024 were included in the analysis if they had: ≥2 claims for melanoma at least 7 days apart, melanoma as the primary tumor, ≥1 code for a systemic melanoma treatment, ≥1 code for metastatic disease, and had progressed to 2L treatment. Included pts had ≥3 months of continuous enrollment before the index date (first melanoma claim). Claims-based algorithms were used to identify monotherapy/combination regimens, by line of treatment (LOT). A Sankey diagram was constructed to illustrate the exact treatment pattern flows between LOT1 and LOT2.
RESULTS: 4,677 patients met study criteria and had progressed to a 2L regimen. 58% were male and the median age was 63.5 years. Among these patients, the most common 1L regimens were immune checkpoint inhibitors (ICI) (n=3,459, 74.0%): pembrolizumab (n=1,196, 25.6%), nivolumab (n=1,124, 24.0%), nivolumab+ipilimumab (n=1,020, 21.8%), nivolumab+relatlimab (n=101, 2.2%) or other anti-PD-1 therapy (n=18, 0.3%). Other frontline treatments received were targeted therapy for BRAF-V600 mutation (n=881, 18.8%), chemotherapy (n=187, 4.0%) or other regimens (n=168, 3.6%). After progression to 2L, the treatments became more heterogeneous with decreased utilization of ICI therapy (n=2,402, 50.3%). The most common 2L therapies were targeted therapy for a BRAF-V600 mutation (n=1,335, 28.5%), nivolumab (n=786, 16.8%), pembrolizumab (n=742, 15.9%), nivolumab+ipilimumab (n=741, 15.8%), chemotherapy (n=304, 6.5%) or other (n=685, 14.6%).
CONCLUSIONS: Real-world treatment patterns suggest that patients with advanced melanoma who fail 1L therapy have no clear standard of care as the 2L treatment landscape is heterogenous.
METHODS: Adults in a large administrative claims database between 1/2018-6/2024 were included in the analysis if they had: ≥2 claims for melanoma at least 7 days apart, melanoma as the primary tumor, ≥1 code for a systemic melanoma treatment, ≥1 code for metastatic disease, and had progressed to 2L treatment. Included pts had ≥3 months of continuous enrollment before the index date (first melanoma claim). Claims-based algorithms were used to identify monotherapy/combination regimens, by line of treatment (LOT). A Sankey diagram was constructed to illustrate the exact treatment pattern flows between LOT1 and LOT2.
RESULTS: 4,677 patients met study criteria and had progressed to a 2L regimen. 58% were male and the median age was 63.5 years. Among these patients, the most common 1L regimens were immune checkpoint inhibitors (ICI) (n=3,459, 74.0%): pembrolizumab (n=1,196, 25.6%), nivolumab (n=1,124, 24.0%), nivolumab+ipilimumab (n=1,020, 21.8%), nivolumab+relatlimab (n=101, 2.2%) or other anti-PD-1 therapy (n=18, 0.3%). Other frontline treatments received were targeted therapy for BRAF-V600 mutation (n=881, 18.8%), chemotherapy (n=187, 4.0%) or other regimens (n=168, 3.6%). After progression to 2L, the treatments became more heterogeneous with decreased utilization of ICI therapy (n=2,402, 50.3%). The most common 2L therapies were targeted therapy for a BRAF-V600 mutation (n=1,335, 28.5%), nivolumab (n=786, 16.8%), pembrolizumab (n=742, 15.9%), nivolumab+ipilimumab (n=741, 15.8%), chemotherapy (n=304, 6.5%) or other (n=685, 14.6%).
CONCLUSIONS: Real-world treatment patterns suggest that patients with advanced melanoma who fail 1L therapy have no clear standard of care as the 2L treatment landscape is heterogenous.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P29
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology