TREATMENT PATTERNS AMONG PATIENTS DIAGNOSED WITH ADVANCED MELANOMA IN A COMMERCIALLY INSURED POPULATION

• Published in: Value in health 2017-05, Vol.20 (5), p.A124
• Main Authors: Atkins, M, Gupte-Singh, K, Stafkey-Mailey, D, Yue, B, Rao, S
• Format: Article
• Language: English
• Subjects: Chemotherapy; Comorbidity; Cytokines; Immune checkpoint; Inhibitor drugs; Medical diagnosis; Melanoma; Metastases; Metastasis; Monoclonal antibodies; Oncology; Patients; Pembrolizumab; Skin melanoma; Targeted cancer therapy
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: The objective of this study is to describe treatment patterns in patients with advanced melanoma since the approval of checkpoint inhibitors (CI) and targeted therapies (TT). METHODS: The study used a retrospective cohort design using IMS PharMetrics claims data from 07/01/2011-03/31/2016. Adults with a diagnosis of metastases (index date) and melanoma were eligible for inclusion. Patients were followed for 6-months preindex and a minimum of 1-month postindex or until lost to follow-up. The proportion of patients and duration of therapy during first and second lines of therapy (LOT) were assessed overall, by therapy class (CI, TT, cytokines, and chemotherapy), and by individual treatments. Trends in treatments were assessed across years (2012-2016Q1). RESULTS: Of the 4,487 patients included, 41.8% had stage 4 disease, 60.6% were male, mean age 54.9 (±12.8) years, mean Charlson comorbidity index score 0.4 (±0.9), and 33.6% initiated first-LOT and 11.5% second-LOT. From 2012-2016Q1, CI use increased in first-LOT (28.8%-79.5%) and second-LOT (45.7%-90.3%). Among CI users, use of nivolumab monotherapy (first-LOT:4.7%-25.8%; second-LOT:7.3%-44.6%) and in combination with ipilimumab increased (first-LOT:4.1%-13.5%; second-LOT:4.5%-26.8%), whereas use of pembrolizumab monotherapy increased in first-LOT (17.0%-28.1%) and decreased in second-LOT (48.2%-17.9%) from 2015-2016Q1. From 2012-2016Q1, TT use decreased in first-LOT (26.6%-13.4%) and second-LOT (35.8%-6.5%). Among TT users, use of dabrafenib and trametinib combination increased (first-LOT:58.1%-80.0%; second-LOT:15.4%-25.0%), whereas use of vemurafenib/dabrafenib/trametinib monotherapy decreased (first-LOT:84.9%-6.7%; second-LOT:96.6%-50.0%) from 2012-2016Q1. The median duration of CI and TT use was 57 and 121 days for first-LOT, and 64 and 117 days for second-LOT, respectively. Among patients receiving CI first-LOT, 34.7% received second-LOT (58.1% CI; 29.8% TT). Similarly among patients receiving TT first-LOT, 39.8% received second-LOT (50.9% CI; 41.3% TT). CONCLUSIONS: Results suggest quick adoption of newly approved treatments for advanced melanoma. Additional data segregated by BRAF status are needed to determine optimal treatment sequencing.