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Outcomes in Melanoma Patients Treated with BRAF/MEK-Directed Therapy or Immune Checkpoint Inhibition Stratified by Clinical Trial versus Standard of Care
- Source :
- Oncology. 93(3)
- Publication Year :
- 2017
-
Abstract
- Objectives: Since 2011, metastatic melanoma treatment has evolved with commercial approval of BRAF- and MEK-targeted therapy and CTLA-4- and PD-1-blocking antibodies (immune checkpoint inhibitors, ICI). While novel therapies have demonstrated improved prognosis in clinical trials, few studies have examined the evolution of prognosis and toxicity of these drugs among an unselected population. We assess whether survival and toxicity reported in trials, which typically exclude most patients with brain metastases and poor performance status, are recapitulated within a commercial access population. Methods: 182 patients diagnosed with stage IV melanoma from July 2006 to December 2013 and treated with BRAF- and/or MEK-targeted therapy or ICI were prospectively studied. Outcomes and clinicopathologic differences between trial and commercial cohorts were assessed. Results: Patients receiving commercial therapy (vs. on trial) had poorer prognostic features (i.e., brain metastases) and lower median overall survival (mOS) when assessed across all treatments (9.2 vs. 17.5 months, p = 0.0027). While toxicity within trial and commercial cohorts did not differ, patients who experienced toxicity had increased mOS (p < 0.001), irrespective of stratification by trial status or therapy. Conclusion: Metastatic melanoma patients receiving commercial treatment may represent a different clinical population with poor prognostic features compared to trial patients. Toxicity may prognosticate treatment benefit.
- Subjects :
- Oncology
Male
Proto-Oncogene Proteins B-raf
Cancer Research
medicine.medical_specialty
Skin Neoplasms
medicine.medical_treatment
Population
Antineoplastic Agents
Targeted therapy
03 medical and health sciences
0302 clinical medicine
Internal medicine
Outcome Assessment, Health Care
medicine
Humans
030212 general & internal medicine
Molecular Targeted Therapy
Adverse effect
education
Melanoma
Mitogen-Activated Protein Kinase Kinases
education.field_of_study
business.industry
Antibodies, Monoclonal
Standard of Care
General Medicine
Immunotherapy
Middle Aged
medicine.disease
Prognosis
Immune checkpoint
Surgery
Clinical trial
Survival Rate
Treatment Outcome
Clinical Trials, Phase III as Topic
030220 oncology & carcinogenesis
Toxicity
Female
business
Subjects
Details
- ISSN :
- 14230232
- Volume :
- 93
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Oncology
- Accession number :
- edsair.doi.dedup.....af9812bcd376e9c09d10db357b5bb275