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
| Therapy | 2011-14 | 2015-16 | ||||
|---|---|---|---|---|---|---|
| Adjuvant | LOT 1 | LOT 2 | Adjuvant | LOT 1 | LOT 2 | |
| BRAF/MEKi | ||||||
| Vemurafenib | 12% | 28% | 12% | 0 | 5% | 5% |
| Dabrafenib/Trametinib | 4% | 21% | 26% | 9% | 43% | 38% |
| Cobimetinib/Vemurafenib | 0 | <1% | 2% | 0 | 4% | 10% |
| Dabrafenib | 0 | 4% | 8% | 0 | 4% | 2% |
| Trametinib | 0 | 2% | 4% | 0 | 1% | 2% |
| CPI | ||||||
| Ipilimumab | 14% | 23% | 20% | 35% | 8% | 5% |
| Pembrolizumab | 1% | 7% | 11% | 7% | 13% | 21% |
| Nivolumab | 0 | 7% | 12% | 9% | 10% | 21% |
| Ipilimumab/Nivolumab | 1% | 6% | 7% | 7% | 15% | 12% |
| Cytokines | 60% | 7% | 1% | 33% | 3% | 0 |
| Chemotherapy | 2% | 4% | 7% | 0 | 3% | 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.