Patterns of treatment and BRAF testing with immune checkpoint inhibitors and targeted therapy in patients with metastatic melanoma presumed to be BRAF positive

Ghate, Sameer; Ionescu‐Ittu, Raluca; Burne, Rebecca; Ndife, Briana; Laliberté, François; Nakasato, Antonio; Duh, Mei Sheng

doi:10.1097/cmr.0000000000000504

Cited by 5 publications

(13 citation statements)

References 44 publications

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“…Similar treatment patterns were also observed in a recent analysis of two US claims databases that evaluated patients with BRAF Mut tumors with claims filed between 1 January 2014 and 30 June 2016 (Truven Health Analytics MarketScan, part of the IBM Watson Health™ business, MI, USA), or 30 September 2016 (IQVIA, NC, USA) [19].…”

Section: Discussionsupporting

confidence: 68%

“…The use of other targeted therapies (i.e., rituximab, bevacizumab, bortezomib and ruxolitinib phosphate) was sparse and occurred mostly as single-agent use in the first- and second-line settings for patients with stage IV melanoma or those who did not meet the criteria for receiving one of the other therapeutic options. Although it has also been suggested that targeted therapy with BRAF/MEK inhibitors may be used for patients with BRAF Mut tumors who have a higher comorbidity burden, including brain metastases [19], recent analyses suggest that checkpoint inhibitors may be the preferred first-line option for patients with brain metastases, given that they appear to result in comparable overall response rates but higher rates of durable intracranial responses [26]. In stage III melanoma, checkpoint inhibitors were used more commonly in BRAF Mut compared with BRAF Wt melanomas, although the reasons for this could not be determined by this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…One prior study was an analysis of EMRs from the Flatiron database (Flatiron Health, NY, USA) that characterized treatment patterns and outcomes in patients with advanced melanoma, primarily in the first-line setting [17], and the other was a study of treatment patterns in the USA focusing on BRAF inhibitor treatment and survival outcomes specifically [18]. A third study focusing on US treatment patterns in relation to BRAF mutation testing from 2014 to 2016 was also performed; however, this analysis used patient claims data [19]. Two studies have assessed EMR data outside of the USA; one study focused on ipilimumab treatment patterns and outcomes in Europe and Australia [20], and the second study described broader treatment patterns and survival outcomes in France [21].…”

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confidence: 99%

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Treatment Patterns of Melanoma by BRAF Mutation Status in the USA from 2011 to 2017: A Retrospective Cohort Study

et al. 2019

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Aim:To describe treatment changes from 2011 to 2017 and demographic/clinical characteristics of patients with advanced melanoma who received systemic therapy by BRAF status.Patients & methods:Treatment patterns were evaluated in adults from the Oncology Services Comprehensive Electronic Records database who received antimelanoma systemic therapy.Results:Checkpoint inhibitors were prevailingly prescribed (66%); usage increased from 2011 (21%) to 2017 (84%). BRAF/MEK inhibitors were the second most common (21%); usage increased from 2011 (6%) to 2012 (18%) and stabilized until 2017 (22%). BRAF/MEK inhibitors (65%) and checkpoint inhibitors (57%) were predominantly used for BRAFMut melanoma.Conclusion:Overall, checkpoint inhibitors have supplanted other therapies for advanced melanoma. Treatment shifts have occurred for BRAFMut melanoma, notably increased use of checkpoint inhibitors and BRAF/MEK combinations compared with monotherapies.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment Patterns of Melanoma by BRAF Mutation Status in the USA from 2011 to 2017: A Retrospective Cohort Study

et al. 2019

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“…To date, three previous observational studies have evaluated IO/TT treatment patterns in patients with BRAF+ advanced melanoma [4,6,8]. In contrast to our study, Luke et al [6] observed that most patients in the realworld setting were treated in 1L with TT (64%), as compared to IO (36%).…”

Section: Relation To Prior Workcontrasting

confidence: 79%

“…To date, three previous observational studies have evaluated IO/TT treatment patterns in patients with BRAF+ advanced melanoma [4,6,8]. In contrast to our study, Luke et al .…”

Section: Discussioncontrasting

confidence: 61%

Real-world outcomes of different lines and sequences of treatment in BRAF-positive advanced melanoma patients

et al. 2022

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The objective of this study is to compare efficacy with different treatment sequences and lines of treatment among BRAF V600 mutated (BRAF+) advanced melanoma patients with immunotherapies (IO) and targeted therapies (TT) using real-world data. This was a retrospective cohort study using the Novartis BRAF+ meLanoma patients ObsErvational database, the harmonized customized data from Flatiron and ConcertAI. The study included BRAF+ advanced unresectable melanoma patients treated with first-line (1L) IO or TT between 1 January 2014 and 31 May 2020. Patient characteristics and treatment patterns were described. Kaplan–Meier curves and propensity score-adjusted Cox models were used for analyzing progression-free survival (PFS) and overall survival (OS). A total of 1961 patients were included, of which, 57.2% received IO and 42.8% received TT on 1L therapy. Overall, 603 patients initiated a 2L therapy: 56.2% IO and 43.8% TT. Regardless of treatment sequence, patients progressed at a relatively similar rate with no significant difference between groups (median PFS: 12.9 months for 1L TT/2L IO and 13.1 months for 1L IO/2L TT; HR, 0.84; P = 0.137). The 2-year OS rate was also similar with 1L TT/2L IO and 1L IO/2L TT (78% vs. 80%; HR, 1.09; P = 0.730). PFS was worse on 2L therapy compared with 1L (median 4.7 vs. 6.5 months). Efficacy on 2L therapy was poor compared with 1L. Among patients who received 2L therapy, regardless of treatment sequences, outcomes were comparable between 1L TT/2L IO and 1L IO/2L TT in this study that reflects real-world experiences beyond clinical trial selective eligibility criteria.

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Real‐world treatment patterns and outcomes for patients with advanced melanoma treated with immunotherapy or targeted therapy

Lee

Bennett

Zhou

et al. 2023

Pharmacoepidemiology and Drug

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Objective To identify real‐world patterns of first line treatment, treatment sequence and outcomes for older adults diagnosed with advanced melanoma who received immunotherapy or targeted therapy. Methods The study population included older adults (ages 65+) diagnosed with unresectable or metastatic melanoma between 2012 and 2017 and who received first line immunotherapy or targeted therapy. Using the linked surveillance, epidemiology, and end results‐medicare data, we described patterns of first line treatment and treatment sequence through 2018. We used descriptive statistics to report patient and provider characteristics by first line treatment receipt and changes in first line therapy use over calendar time. We also described overall survival (OS) and time to treatment failure (TTF) by first line treatment using the Kaplan–Meier method. For patterns of treatment sequence, we reported commonly observed treatment switch patterns by treatment sub‐category and calendar year. Results The analyses included 584 patients (mean age = 76.3 years). A majority (n = 502) received first line immunotherapy. There was a sustained increase in immunotherapy uptake, most notably from 2015 to 2016. The estimated median OS and TTF were longer with first line immunotherapy than with targeted therapy. Individuals treated with CTLA‐4 + PD‐1 inhibitors had the longest median OS (28.4 months). The most common treatment switch pattern was from a first line CTLA‐4 inhibitor to a second line PD‐1 inhibitor. Conclusions Our findings inform understanding of treatment patterns of currently used immunotherapies and targeted therapies in older adults with advanced melanoma. Immunotherapy use has increased steadily with PD‐1 inhibitors becoming a dominant treatment option since 2015.

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Patterns of treatment and BRAF testing with immune checkpoint inhibitors and targeted therapy in patients with metastatic melanoma presumed to be BRAF positive

Abstract: Supplemental Digital Content is available in the text.

Cited by 5 publications

References 44 publications

Treatment Patterns of Melanoma by BRAF Mutation Status in the USA from 2011 to 2017: A Retrospective Cohort Study

Treatment Patterns of Melanoma by BRAF Mutation Status in the USA from 2011 to 2017: A Retrospective Cohort Study

Real-world outcomes of different lines and sequences of treatment in BRAF-positive advanced melanoma patients

Real‐world treatment patterns and outcomes for patients with advanced melanoma treated with immunotherapy or targeted therapy

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