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The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma: results from a European expert panel study

Authors :
Lars Bastholt
Ivan Marquez Rodas
Jochen Utikal
Pier Francesco Ferrucci
Harriet Tuson
Luc Thomas
Miranda Payne
Pascal Wolter
Caroline Robert
J McKendrick
Johan Hansson
Paolo A. Ascierto
Amber Kudlac
Source :
Melanoma Research, Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid, Consejería de Sanidad de la Comunidad de Madrid, Ascierto, P A, Bastholt, L, Ferrucci, P F, Hansson, J, Márquez Rodas, I, Payne, M, Robert, C, Thomas, L, Utikal, J S, Wolter, P, Kudlac, A, Tuson, H & McKendrick, J 2018, ' The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma : Results from a European expert panel study ', Melanoma Research, vol. 28, no. 4, pp. 333-340 . https://doi.org/10.1097/CMR.0000000000000455
Publication Year :
2018

Abstract

Supplemental Digital Content is available in the text.<br />Treatment decisions for advanced melanoma are increasingly complex and guidelines provide limited advice on how to choose between immunotherapy and targeted therapy for first-line treatment. A Delphi study was carried out to understand which patient characteristics and disease-related factors inform clinicians’ choices of first-line treatment for BRAF-mutated melanoma. Twelve European melanoma specialists experienced in using immunotherapies and targeted agents participated in a double-blind two-phase Delphi study. In phase 1, participants completed a questionnaire developed after reviewing patient characteristics and disease-related factors reported in trials, clinical guidelines, and health technology assessments. Phase 2 was an expert panel meeting to explore outstanding issues from phase 1 and seek consensus, defined as 80% agreement. Twenty patient-related and disease-related characteristics were considered. There was consensus that tumor burden (83% of clinicians) and disease tempo (83%) are very or extremely important factors when selecting first-line treatment. Several components were deemed important when assessing tumor burden: brain metastases (82% of clinicians) and location of metastases (89%). There was consensus that disease tempo can be quantified in clinical practice, but not on a formal classification applicable to all patients. Lactate dehydrogenase level is a component of both tumor burden and disease tempo; all clinicians considered lactate dehydrogenase important when choosing first-line treatment. The majority (92%) did not routinely test programmed death ligand-1 status in patients with melanoma. Clinicians agreed that choosing a first-line treatment for advanced melanoma is a complex, multifactorial process and that clinical judgment remains the most important element of decision-making until research can provide clinicians with better scientific parameters and tools for first-line decision-making.

Details

ISSN :
14735636
Volume :
28
Issue :
4
Database :
OpenAIRE
Journal :
Melanoma research
Accession number :
edsair.doi.dedup.....9ee4e9e62e780a228a3f3cccf6e9e120
Full Text :
https://doi.org/10.1097/CMR.0000000000000455