438P - Estimating scenarios for survival time in patients with metastatic melanoma receiving immunotherapy or targeted therapy

Background

A strong understanding of life expectancy allows advanced cancer patients to plan for their future. Unfortunately, many patients do not understand their prognosis. Estimating survival in metastatic melanoma is particularly difficult, as immunotherapy and targeted therapies have revolutionized care.

Methods

We aimed to determine whether three survival scenarios (worst-case, typical, best-case), calculated using multiples of median overall survival ([OS], 0.25x, 0.5-2x, 3x, respectively), accurately estimate prognosis for metastatic melanoma patients receiving immunotherapy or targeted therapy. We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials for phase II/III randomized controlled trials (treatment arms n ≥90) of patients with unresectable stage IIIC/IV cutaneous melanoma receiving immunotherapy or targeted therapy from 01/2001 to 02/2022. We extracted survival data and compared it to our multiples of median OS to the extracted survival times.

Results

26 trials (12,345 patients) were included. Our estimates of worst-case scenarios ranged from 3.29 to 6.82 months; most-likely (lower-typical) from 6.57 to 13.64 and (upper-typical) from 26.28 to 54.55 months; and best-case from 39.43 to 81.83 months, among patients receiving first-line targeted and immunotherapy, respectively. Our multiples of the median OS accurately estimated survival from anywhere between 16.7% to 100% of estimates. Our scenarios tended to be more accurate for those receiving targeted (most between 70% to 100% accuracy) than immunotherapy (some as low as 16.7%); and second- (all between 50% to 100%) than first-line (some as low as 16.7%) treatment. We were unable to estimate scenarios for patients receiving first-line combination immunotherapy, as none of the arms in this group met median OS. When we were inaccurate, we tended to overestimate.

Conclusions

This study was limited by small sample sizes and immature data. The accuracy of our scenarios was more variable than previous work done by our team. Future research should include mature data and novel interventions when determining frameworks to communicate survival in metastatic melanoma.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

megan megan smith-uffen.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.