4491 - Advanced melanoma treatment patterns in the modern era: United Kingdom (UK) real world retrospective chart review study

Background

In 2016, all licensed single agent and combination BRAF-targeted therapies (BT) and checkpoint inhibitors (CI) were approved for advanced melanoma in the UK. An evaluation of treatment choices in routine clinical practice was undertaken.

Methods

A retrospective chart review was conducted in 7 UK cancer centres, which included patients ≥18 years old with advanced melanoma who started 1^st-line (1L) therapy and received at least 1 dose between July 2016 and June 2017. Patients taking part in clinical trials were not eligible. Patient demographics, disease characteristics, and 1L and subsequent therapy lines were recorded. Interim analyses were descriptive.

Results

280 patients were followed for median 9 (range: <1-19) months; 80%, 19%, and 1% patients received 1, 2, or 3 therapy lines. 92% of patients had BRAF testing, 26% had NRAS testing, and <1% of tumours were tested for PDL1. BRAF and NRAS mutation rates were 41% and 7%, respectively. 73% of patients received CIs 1L: 46% pembrolizumab (Pem), 26% nivolumab+ipilimumab (N+I), 1% ipilimumab (Ipi), <1% nivolumab (N); 27% patients received BT 1L: 20% dabrafenib+trametinib (D+T), 7% dabrafenib (D). 38% of BRAF mutant patients received 1L CI. Most common reasons for therapy selection were biomarker status (42%) and perceived benefit (27%). Two-thirds of patients discontinued 1L therapy (BT: 76%, CI: 62%), 79% within 6 months of starting. Most common reasons for stopping were adverse events for N+I (59%) and progressive disease for BT and Pem (54% each). 40% of patients who discontinued BT received 2^nd-line (2L) therapy 71% N+I, 29% Pem, <1% vemurafenib. 17% of patients who discontinued Pem received 2L therapy: 57% Ipi, 21% BT (7% D+T, 14% D), 14% other, and 7% trial agents. 41% of patients who discontinued N+I received 2L therapy: 63% BT (58% D+T, 5% D), 21% Pem, 8% other, and 8% trial agents.

Conclusions

The most common 1L therapy was CI. BRAF mutation status, however, influenced treatment choice, with two-thirds of BRAF mutant melanoma patients receiving BT 1L. More than double the number of patients receiving BT and N+I 1L received 2L therapy compared with patients receiving Pem 1L. Further exploration of these data will be presented.

Clinical trial identification

Legal entity responsible for the study

Bristol-Myers Squibb.

Funding

Bristol-Myers Squibb.

Editorial Acknowledgement

Disclosure

J.J. Sacco: Lead investigator: Clatterbridge hospital which is a site participating in this chart review study which received funding from BMS. P.G. Corrie: Lead investigator from Addenbrooke's hospital which is a site participating in this chart review study which received funding from BMS. O. Oladipo: Lead investigator from Belfast City hospital which is a site participating in this chart review study which received funding from BMS. M. Payne: Lead investigator from Churchill hospital which is a site participating in this chart review study which received funding from BMS. J. Larkin, T. Talbot: Lead investigator from Royal Marsden hospital which is a site participating in this chart review study which received funding from BMS. J. Wagstaff: Lead investigator from Singleton hospital which is a site participating in this chart review study which received funding from BMS. S. Cheetham: Data manager from Addenbrooke's hospital which is a site participating in this chart review study which received funding from BMS. D. Stein, M. Soni, C. Coombs: Employee of Evidera. Evidera received funding from BMS for development of this abstract. A. Amadi, M. Wang, J. Ellis: Employee of BMS.