Overall survival (OS) in metastatic melanoma since the introduction of immunotherapy: A National Cancer Database analysis.

Authors

null

Sunny R K Singh

Henry Ford Cancer Institute (HFCI)- Henry Ford Hospital, Detroit, MI

Sunny R K Singh , Sindhu Janarthanam Malapati , Rohit Kumar , Ding Wang

Organizations

Henry Ford Cancer Institute (HFCI)- Henry Ford Hospital, Detroit, MI, Van Elslander Cancer Center-Ascension St John Hospital, Detroit, MI, Division of Hematology and Medical Oncology, James Brown Graham Cancer Center, University of Louisville, Louisville, KY, Henry Ford Hospital, Detroit, MI

Research Funding

No funding received
None

Background: Metastatic melanoma historically had a very poor prognosis and survival until the utilization of immunotherapy. Ipilimumab, the first immune checkpoint (ICP) inhibitor was approved in March 2011, followed soon after by the approval of PD-1 and PD-L1 inhibitors. We aim to conduct a real-world analysis of survival outcomes before and after 2011 in metastatic melanoma and its subtypes. We will also explore the impact of race on the clinical presentation and outcomes of melanoma. Methods: Adults with metastatic melanoma were identified from the NCDB (2004-2015). Kaplan Meier method was used to estimate survival and Cox proportional hazards model was used to determine hazard ratio (HR) for death after adjusting for age, race, sex, comorbidity index, melanoma type, education, income, insurance, facility type and geographical location. Odds of having metastatic disease at diagnosis were estimated using multivariate log regression analysis. Results: Of the 20,691 metastatic melanoma cases, 19,492 (94.2%) were cutaneous, 326 (1.6%) were ocular and 873 (4.2%) were mucosal. The effect of immunotherapy use on survival in metastatic melanoma was assessed by comparing years 2011-2015 versus 2004-2010. After the introduction of immunotherapy in 2011, the adjusted survival for metastatic melanoma had improved in Caucasians (HR 0.80, p < 0.001, CI 0.77-0.83) but not in African Americans (HR 0.80, p value = 0.08, CI 0.62-1.03). Although, AA constituted a minority in each melanoma group (1.7% cases of cutaneous, 1.5% of ocular and 8.1% of mucosal melanoma), their odds of having metastatic disease at onset was higher in both cutaneous (OR 2.60, p < 0.001 CI 2.28-2.95) and mucosal melanoma (OR 1.85, p < 0.001 CI 1.39-2.47) compared to Caucasians. Conclusions: Real-world data suggested a 20% improvement in survival of metastatic melanoma since the introduction of ICP inhibitors except in the subgroups of ocular melanoma and African Americans. The disproportionately high odds of metastatic disease at presentation in African American patients with melanoma suggests the need for improvement in care delivery, specifically in terms of early detection.

Metastatic MelanomaAllCutaneousOcularMucosal
Median OS 2004-2010 (months)8.088.119.367.36
Median OS 2011-2015 (months)10.3510.359.1010.71
Adjusted HR (OS 2011-2015 vs 2004-2010)0.80 (p < 0.001)0.80 (p < 0.001)1.09 (p = 0.5)0.73 (p < 0.001)
3-year survival 2004-2010 (%)14.2414.6411.365.53
3-year survival 2011-2015 (%)20.3621.1011.888.60

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Publication Only

Session Title

Publication Only: Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Real-World Data/Outcomes

Citation

J Clin Oncol 38: 2020 (suppl; abstr e19333)

DOI

10.1200/JCO.2020.38.15_suppl.e19333

Abstract #

e19333

Abstract Disclosures