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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

3670 - Treatment patterns of melanoma by BRAF mutation status in the US in 2011-2017: a retrospective cohort study

Date

21 Oct 2018

Session

Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

Presenters

Leon Raskin

Citation

Annals of Oncology (2018) 29 (suppl_8): viii442-viii466. 10.1093/annonc/mdy289

Authors

L. Raskin1, S. Shah2, M. Braunlin1, J. Buchanan2, D. Cohan3

Author affiliations

  • 1 Global Center For Observational Research, AMGEN (Headquarters) - USA, 91320-1799 - Thousand Oaks/US
  • 2 Global Health Economics, AMGEN (Headquarters) - USA, 91320-1799 - Thousand Oaks/US
  • 3 Medical Affairs, AMGEN (Headquarters) - USA, 91320-1799 - Thousand Oaks/US
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Resources

Abstract 3670

Background

New therapies have changed melanoma treatment after 2011; however, these changes have not been studied well, especially in BRAFMut melanomas.

Methods

We studied 4197 melanoma patients who received systemic therapy in 2011-17 in the US electronic medical record database OSCER. Among these, 1687 (40%) were studied for treatments by line of therapy (LOT) and biomarkers from 2011-16.

Results

Therapies included: 64% checkpoint inhibitors (CPI), 19% BRAF/MEK inhibitors (BRAF/MEKi), 17% chemotherapy, 16% cytokines, and 1% oncolytic viral therapy. In 2011-17, overall CPI use increased from 23% to 81% (pembrolizumab 32%, nivolumab 23%, ipilimumab/nivolumab 21%) but ipilimumab use decreased to 13%. BRAF/MEKi use did not change (20-21%) but vemurafenib (2% in 2017) was replaced by dabrafenib/trametinib and cobimetinib/vemurafenib (14% and 4%). Cytokine and chemotherapy use declined (43% to 3% and 35% to 7%, respectively). During 2011-17, CPI and BRAF/MEKi were used more in LOT 1-4 (60% and 25%) than as adjuvant (30% and 2%), whereas cytokines were used as adjuvant only (64%). CPI were used most in NRASMut (85%) and less in BRAFMut, BRAFwt, or NRASwt (57-66%). In BRAFMut, CPI use was higher in stage III (62%) than IV (52%) unlike in BRAFwt (52% stage III vs. 90% stage IV). BRAFi were used in 65% of BRAFMut, more in stage IV than III (79% vs. 34%). BRAFMut and NRASMut received less adjuvant therapy than wild-type (20-22% vs. 28-31%) but more LOT (BRAFMut had 89% LOT 1, 37% LOT 2, 13% LOT 3, 5% LOT 4+). The table compares treatment changes in BRAFMut melanoma between 2011-14 and 2015-16.Table: 1280P

Treatment changes in BRAFmut melanoma between 2011-14 and 2015-16

Therapy2011-142015-16
AdjuvantLOT 1LOT 2AdjuvantLOT 1LOT 2
BRAF/MEKi
Vemurafenib12%28%12%05%5%
Dabrafenib/Trametinib4%21%26%9%43%38%
Cobimetinib/Vemurafenib0<1%2%04%10%
Dabrafenib04%8%04%2%
Trametinib02%4%01%2%
CPI
Ipilimumab14%23%20%35%8%5%
Pembrolizumab1%7%11%7%13%21%
Nivolumab07%12%9%10%21%
Ipilimumab/Nivolumab1%6%7%7%15%12%
Cytokines60%7%1%33%3%0
Chemotherapy2%4%7%03%0

Conclusions

Checkpoint inhibitors have replaced other advanced melanoma therapies, providing more treatment options to patients with BRAFMut melanoma.

Clinical trial identification

Legal entity responsible for the study

Amgen Inc.

Funding

Amgen Inc.

Editorial Acknowledgement

Disclosure

L. Raskin: Employee, Stock ownership: Amgen Inc. S. Shah, J. Buchanan, D. Cohan: Employee, Stockholder: Amgen Inc. All other authors have declared no conflicts of interest.

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