429P - Demographics, pattern of care, and outcome analysis of malignant melanoma cases from a tertiary care centre in India

Background

Melanoma care is revolutionized with checkpoint inhibitors (CPI) and targeted therapies; however, access to drugs is challenging in Low-Middle income countries (LMICs).

Methods

Histologically proven melanoma cases registered from 2013–2019 were analysed.

Results

There were 443 patients with median age of 54 years; 60% were males with 41% cutaneous, and 57% mucosal melanomas; most common primary sites were anorectal (41%) and extremities (27%); 11% were BRAF mutated. Among the 258 non-metastatic patients, the median follow up was 30 months (0–83 months). Of these, 114 (44%) had prior surgery and 73 (64%) were already metastatic at presentation to us. Of the remaining 144 (56%), 101 underwent resection, 11 were unresectable, and rest 32 did not take treatment. Median EFS of non-metastatic patients was 17 (95% CI: 11-23) months while median OS was 38 months (95% CI: 30-46); 2-years OS predictions was 66% (95% CI: 59-73). Overall metastatic cohort (n=311) comprised of baseline metastatic (n=185) and non-metastatic patients with (73) or without prior therapy (53) who failed with distant metastasis.Commonest metastatic sites were liver (52%) and non-regional nodes (51%). Median follow up in this cohort was 21 (0–74 months); 138 (44.4%) received chemotherapy(taxane, dacarbazine), Interferons, while 29 (9.3%) patients received CPI. The clinical benefit rate was 31%. In baseline metastatic cohort, the median EFS and OS with BSC alone were 3.8 (95% CI: 2.6-5.0) months and 3.5 (95% CI: 2.45-4.63) vs. 5.55 (95% CI: 3-8) months and 11 (95% CI: 9-13.1) months in any systemic therapy group (HR for OS: 0.34, 95% CI: 0.22-0.52; P<0.001). Grade 3/4 toxicity were observed in 16 % with predominance of thrombocytopenia and anemia (both 4%) in chemotherapy and anemia (10%) for CPI. Any therapy received was significant in both cohort;additionally, site, surgery, were significant in non-metastatic cohort.

Conclusions

This real-world data from India reflects the hard reality of access of expensive, standard of care therapies. Interesting finding that any systemic therapy can lead to meaningful clinical benefits at-least in a select group of patients merits exploration if standard options are not feasible, especially in LMICs.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.