New efficacious systemic therapies for advanced melanoma have been practice changing. More recently these therapies have been tested in the adjuvant setting for stage III disease with positive results. With recent FDA and EMA approvals for stage III disease we wished to evaluate current uptake of adjuvant therapies for stage III melanoma. Such benchmark data will be important in testing our ability to integrate clinical trial data into clinical practice.
We identified 34,376 stage III patients from the National Cancer Database (NCDB) diagnosed 2004-2015 with known extent of LN surgery and no prior invasive cancer. Use of adjuvant chemotherapy (including targeted therapy), immunotherapy and radiation therapy was assessed. Cochran-Armitage trend tests were used to test for changes in proportions over time overall and stratified by substage.
Of the 34,376 patients, median age 57 years, 21,093 (61.4%) were male and 33,300 Caucasian (97.7%). The median (mean) number of positive nodes was 1 (2.1), IQR 1-2, range 1-81. Overall, 9,180 patients (27.4%) received adjuvant immunotherapy, 2,467 (7.5%) adjuvant chemotherapy and 3,088 (9.1%) adjuvant radiation. Any adjuvant therapy use declined over time from 41.9% in 2004 to 35.8% in 2015 (p < 0.001), as did immunotherapy specifically (30.6% in 2004 to 25.3% in 2015, p < 0.001). Use of any adjuvant therapy correlated with disease burden (49.9% for ≥2LN+ vs 34.6% for 1LN+, p < 0.001) and substage: Stage IIIA 33.3%, Stage IIIB 38.8%, Stage IIIC 51.7%. Use of any adjuvant therapy significantly decreased from 2004 to 2015 in both IIIA (39.9% to 22.9%) and IIIB substages (44.0% to 35.4%), each p < 0.001, while stable among Stage IIIC patients (50.6% to 52.4%, p = 0.50). Use of immunotherapy followed a similar trend (Stage IIIA 33.4% to 19.1%, p < 0.001, Stage IIIB 31.1% to 27.5%, p < 0.001, Stage IIIC 30.6% to 31.7%, p = 0.76).
These data provide benchmarks for adjuvant therapy uptake for stage III melanoma patients reflective of general clinical practice. Future study with integration of adjuvant systemic therapies tested in clinical trials into the general cancer population should utilize these data to test the uptake of newer adjuvant treatments.
Clinical trial identification
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Has not received any funding.
All authors have declared no conflicts of interest.