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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
- Source :
- Cancer Medicine, Vol 9, Iss 21, Pp 7863-7878 (2020), Cancer Medicine
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
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.<br />While both aPD‐1 and BRAF/MEKi are approved for BRAF‐mutant advanced melanoma, limited evidence exists comparing these therapies, particularly to understand the optimal treatment sequence. This study provides evidence of a clinical benefit of first‐line (1L) aPD‐1 compared to BRAF/MEKi after 6 months among patients with BRAF‐mutant advanced melanoma who received care in a large network of US community oncology clinics.
- Subjects :
- 0301 basic medicine
Oncology
Male
Cancer Research
Skin Neoplasms
Time Factors
Programmed Cell Death 1 Receptor
Medical Oncology
immunology
0302 clinical medicine
Risk Factors
Medicine
Community Health Services
Molecular Targeted Therapy
Immune Checkpoint Inhibitors
Melanoma
Original Research
Community based
Aged, 80 and over
Middle Aged
MAP Kinase Kinase Kinases
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Progression-Free Survival
030220 oncology & carcinogenesis
Female
Drug Utilization
Adult
Proto-Oncogene Proteins B-raf
medicine.medical_specialty
First line
Risk Assessment
survival
lcsh:RC254-282
03 medical and health sciences
Internal medicine
Humans
Radiology, Nuclear Medicine and imaging
Protein Kinase Inhibitors
Advanced melanoma
Aged
Retrospective Studies
Adult patients
business.industry
target therapy
Clinical Cancer Research
biomarkers
Retrospective cohort study
030104 developmental biology
Propensity score matching
Mutation
Observational study
business
Subjects
Details
- Language :
- English
- ISSN :
- 20457634
- Volume :
- 9
- Issue :
- 21
- Database :
- OpenAIRE
- Journal :
- Cancer Medicine
- Accession number :
- edsair.doi.dedup.....96fc6bc46c16e1f918585ef9a89a846d