Patterns of use of systemic therapies among patients with metastatic melanoma: a retrospective claims database analysis in the United States

Ma, Qisheng; Chen, Yaozhu Juliette; Hines, Dionne M.; Munakata, Julie; Batty, Nicolas; Barber, Beth; Zhao, Zhongyun

doi:10.1080/09546634.2016.1277176

Cited by 6 publications

(8 citation statements)

References 16 publications

(20 reference statements)

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“…Prior real-world research has demonstrated that most patients (56.8%) in the US are diagnosed with metastatic melanoma after the age of 55 and the malignancy is more common among male (62.5%) patients. [30] These trends were reflected in our results, which found that, among patients who initiated 1L treatment, nearly half of patients were under 65 years, with majority being Caucasian and/or male.…”

Section: Discussionsupporting

confidence: 52%

“…In a retrospective claims analysis, Ma et al found that among metastatic melanoma patients treated in the US between January 2011 and August 2013, most patients (39%) received ipilimumab, 35% vemurafenib, 19% temozolomide and 7% dacarbazine. [30] By analyzing a more recent EHR dataset from Flatiron Health, Whitman et al reported that the most common 1L regimens observed in their retrospective EHR-based analysis of advanced melanoma patients treated through February 2017 were ipilimumab-based regimens (34%), anti-PD1 monotherapy (26%) and BRAF/MEK inhibitors (20%). [29] The greater utilization of anti-PD1 monotherapies and BRAF/MEK combination therapy found in this study relative to the Ma et al and Whitman et al studies likely reflects advancements in the treatment landscape for melanoma, particularly recent approvals of anti-PD1 therapies in 2014.…”

Section: Discussionmentioning

confidence: 99%

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Real-world treatment patterns and clinical outcomes among patients with advanced melanoma

et al. 2019

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Recently, the effectiveness of novel immune checkpoint inhibitors and BRAF-directed therapies has been demonstrated in advanced melanoma trial populations. Limited research, however, has evaluated the impact of these therapies in a real-world setting. The aim of this study was to evaluate treatment patterns and clinical outcomes among advanced melanoma patients treated with modern therapies within community oncology clinics. Adult patients with advanced melanoma who initiated treatment within the US Oncology Network between 1/1/14 and 12/31/16 were included. Data were sourced from electronic healthcare records. Patients were followed through 12/31/17. Descriptive analyses were performed to assess patient and treatment characteristics and Kaplan–Meier methods were used for time-to-event outcomes. In total, 484 patients met eligibility criteria (32.0% with brain metastasis, 12.6% with Eastern Cooperative Oncology Group performance status ≥2). In the first-line (1L) setting during the study period, 37.0% received anti-PD1 monotherapies, 26.4% ipilimumab monotherapy, 19.8% BRAF/MEK combination therapy, 6.4% BRAF or MEK monotherapy, 4.1% ipilimumab/nivolumab combination therapy and 6.2% other regimens. Differences in baseline demographic and clinical characteristics were observed across treatment groups. For the overall study population, the median (95% confidence interval) estimates for overall survival, time to next treatment and progression-free survival were 20.7 (16.0, 26.8), 5.8 (5.3, 6.5), and 4.9 (4.2, 5.7) months, respectively. The results of this study provide real-world insight into advanced melanoma treatment trends and clinical outcomes, including high utilization of immunotherapies and BRAF/MEK combination therapy. Future research can explore underlying differences in patient subpopulations and the sequence of therapies across lines of therapy.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns and clinical outcomes among patients with advanced melanoma

et al. 2019

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“…Since cancer staging information is not available in administrative claims, we used an operational algorithm similarly used in previous observational studies to identify patients with metastatic melanoma. 8,[14][15][16][17][18][19] Figure 1 illustrates a graphical representation of the algorithm and the implemented study methods, adapted from the Repeat Initiative's recommendations on study design visualizations. 20 We defined a case of metastatic melanoma as an initiator of one of the commonly used first-line therapies available over the course of the study period.…”

Section: Data Source and Study Populationmentioning

confidence: 99%

Health Care Utilization and Costs Associated With Systemic First-Line Metastatic Melanoma Therapies in the United States

Boemmel-Wegmann

Brown

Diaby

et al. 2022

JCO Oncology Practice

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PURPOSE: US Food and Drug Administration approvals of immune checkpoint inhibitors and targeted therapies revolutionized the treatment of metastatic melanoma. Our aim was to assess health care resource utilization and costs for patients with metastatic melanoma treated with systemic therapies in first line between January 2012 and December 2017. METHODS: We conducted a retrospective cohort study of patients with metastatic melanoma using MarketScan data. We included patients diagnosed with melanoma and secondary malignant neoplasm who used pembrolizumab, nivolumab, ipilimumab, ipilimumab plus nivolumab, BRAF-inhibitor (BRAF-i) plus MEK inhibitor (MEK-i), BRAF-i or MEK-i monotherapy, or chemotherapy in first line. We compared health care utilization and costs per patient per month (PPPM) using two-part and generalized linear models. RESULTS: We identified 1,870 patients, including 185 pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab plus ipilimumab, 214 BRAF-i plus MEK-i, 240 BRAF-i or MEK-i monotherapy, and 254 chemotherapy users. Highest PPPM rates of hospitalizations, emergency room visits, and outpatient visits were observed in patients with ipilimumab plus nivolumab therapy (adjusted difference v pembrolizumab [aDiff], 0.18, 0.12, and 0.88, respectively; all P < .001). Ipilimumab monotherapy users (aDiff, 0.07 and 0.93; all P < .001) and chemotherapy users (aDiff, 0.10 and 2.63; all P < .001) showed higher PPPM rates of hospitalizations and outpatient visits compared with pembrolizumab users, respectively. Utilization rates in nivolumab, BRAF-i plus MEK-i, and BRAF-i or MEK-i groups were similar to the pembrolizumab group. Highest PPPM total costs and drug-related costs were observed in the ipilimumab group ($80,139 US dollars [USD] and $70,051 USD; all P < .001), followed by the ipilimumab plus nivolumab ($71,689 USD and $56,217 USD; all P < .001) and the BRAF-i plus MEK-i group ($31,184 USD and $19,648 USD; all P < .001). PPPM costs in the nivolumab group were similar to the pembrolizumab group. CONCLUSION: Significant differences in health care resource utilization and costs were found across first-line metastatic melanoma regimens. Utilization rates were highest in patients using ipilimumab-containing therapies. High drug costs constituted a major fraction of total PPPM health care costs.

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“…Our study has considerable strengths because we analysed a large cohort of unselected patients and presented real-world therapy discontinuation of checkpoint inhibitors, which was not a focus of prior studies 8 , 24 . Our study also has some potential limitations.…”

Section: Discussionmentioning

confidence: 99%

Real-world analyses of therapy discontinuation of checkpoint inhibitors in metastatic melanoma patients

Machado

Moura

Chan

et al. 2020

Sci Rep

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the 'real-world' patient population of metastatic melanoma is not fully represented in clinical trials investigating checkpoint inhibitors. We described therapy discontinuation in an unselected population-based cohort of adults with metastatic melanoma who started therapy with pembrolizumab, nivolumab, or nivolumab/ipilimumab from January 2015 to August 2017. Therapy discontinuation was defined as a gap between doses beyond 120 days, and/or initiation of another cancer therapy. We estimated drug-specific rate ratios for therapy discontinuation adjusted for age, sex, comorbidities, health care use, and past cancer therapies. We included 876 metastatic melanoma patients initiating pembrolizumab (44.3%), nivolumab/ipilimumab (31.2%), and nivolumab (24.5%). At 12 months of follow-up, the probabilities of therapy discontinuation were 49.9% (95% confidence interval, CI 43.6-56.5) for pembrolizumab, 58.8% (95% CI 50.5-67.3) for nivolumab, and 59.2% (95% CI 51.7-66.8) for nivolumab/ipilimumab. Stratified analyses based on prior cancer therapy, brain metastases at baseline, and sex showed similar trends. In multivariable analyses, compared with pembrolizumab, patients starting nivolumab (rate ratio 1.38, 95% CI 1.08-1.77) or nivolumab/ ipilimumab (rate ratio 1.30, 95% CI 1.02-1.65) were more likely to discontinue therapy. Our findings indicate frequent discontinuations of checkpoint inhibitors at one year. The lower discontinuation associated with pembrolizumab should be confirmed in further studies. Each year, over 100,000 new cases of melanoma are diagnosed in North America. Since 2007, melanoma incidence has been on the rise, while death rates have slowly improved 1. In the United States (US), melanoma is the third most prevalent cancer among men and the fifth among woman 2 , and melanoma incidence is higher in men (29.3/100,000 persons per year) than women (17.8/100,000 persons per year) 1. The survivorship considerably reduces from 99% for localized melanoma to 25% for patients diagnosed with distant metastases (5-year relative survival estimates in the US between 2009 and 2015) 1. The advent of checkpoint inhibitors has dramatically changed the landscape of treatment for metastatic melanoma. These agents are so-called because they act on key regulators, called checkpoints, of the immune system to help effectively eradicate cancer cells. In the US, ipilimumab (anti-CTLA-4) was approved in 2011 and pembrolizumab and nivolumab (both inhibitors of the programmed death-1, PD-1, pathway) were launched on the market in 2014. Since 2015, the National Comprehensive Cancer Network (NCCN)'s Clinical Practice Guidelines recommended checkpoint inhibitors as first-line treatment for metastatic melanoma. These guidelines shifted slightly in 2016 when monotherapy with pembrolizumab and nivolumab and combination nivolumab/

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Patterns of use of systemic therapies among patients with metastatic melanoma: a retrospective claims database analysis in the United States

Cited by 6 publications

References 16 publications

Real-world treatment patterns and clinical outcomes among patients with advanced melanoma

Real-world treatment patterns and clinical outcomes among patients with advanced melanoma

Health Care Utilization and Costs Associated With Systemic First-Line Metastatic Melanoma Therapies in the United States

Real-world analyses of therapy discontinuation of checkpoint inhibitors in metastatic melanoma patients

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