Abstract 1081P
Background
The introduction of new systemic treatments for advanced melanoma has markedly changed the outcome of patients with metastatic melanoma. To assure high quality of care for patients treated in Dutch melanoma centers, hospital variation in treatment patterns and outcomes are evaluated in the Dutch Melanoma Treatment Registry. The aim of this study was to assess center variation in treatments and 2-year survival probabilities of patients diagnosed between 2013-2017 in the Netherlands.
Methods
We selected patients diagnosed between 2013-2017 with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry. Centers’ performance on 2-year survival was evaluated using Empirical Bayes estimates calculated in a random-effects model with the use of new systemic therapies as a time-dependent covariate. Treatment patterns of the centers with the lowest and highest estimates for 2-year survival were compared.
Results
For patients diagnosed between 2014-2015, significant center variation in 2-year survival probabilities was observed even after correcting for case-mix and treatment with new systemic therapies. In the year with the largest variation (2014), between-center HRs ranged between 0.72-1.36 relative to the national average. Treatment patterns of the centers with the lowest estimates treated a higher percentage of patients with the anti-PD-1 antibodies (31% vs. 20%) and BRAF/MEK inhibitors (19% vs. 5%) in the first three lines of treatment compared to centers with higher estimates between 2013-2015. The differential use of new systemic therapies partially explained the observed variation. From 2016 onwards, no significant difference in 2-years survival was observed between centers.
Conclusions
Our data suggest that between 2014-2015, after correcting for patient case-mix, significant variation in 2-year survival probabilities between Dutch melanoma centers existed. A platform such as the Dutch Melanoma Treatment Registry, in which melanoma centers collaborate and have insight into variation in treatment patterns and outcomes between centers, results in fast implementation of new clinical developments across all Dutch melanoma centers.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A.J.M. Van den Eertwegh: Non-Financial Interests, Institutional, Advisory Board: BMS; Non-Financial Interests, Institutional, Advisory Board: Roche; Non-Financial Interests, Institutional, Advisory Board: MSD; Non-Financial Interests, Institutional, Advisory Board: Novartis; Non-Financial Interests, Institutional, Research Grant: Roche. J.B.A.G. Haanen: Non-Financial Interests, Institutional, Advisory Role: Amgen; Non-Financial Interests, Institutional, Advisory Role: AstraZeneca; Non-Financial Interests, Institutional, Advisory Role: Bayer; Non-Financial Interests, Institutional, Advisory Role: BMS; Non-Financial Interests, Institutional, Advisory Role: Celsius Therapeutics; Non-Financial Interests, Institutional, Advisory Role: GSK; Non-Financial Interests, Institutional, Advisory Role: Immunocore; Non-Financial Interests, Institutional, Advisory Role: Ipsen; Non-Financial Interests, Institutional, Advisory Role: MSD; Non-Financial Interests, Institutional, Advisory Role: Merck Serono; Non-Financial Interests, Institutional, Advisory Role: Novartis; Non-Financial Interests, Institutional, Advisory Role: Neon Therapeutics; Non-Financial Interests, Institutional, Advisory Role: Pfizer; Non-Financial Interests, Institutional, Advisory Role: Roche/Genentech; Non-Financial Interests, Institutional, Advisory Role: Sanofi; Non-Financial Interests, Institutional, Advisory Role: Seattle Genetics; Non-Financial Interests, Institutional, Research Grant: Novartis; Non-Financial Interests, Institutional, Research Grant: BMS; Non-Financial Interests, Institutional, Research Grant: MSD; Non-Financial Interests, Institutional, Research Grant: Neon Therapeutics. C.U. Blank: Financial Interests, Institutional, Research Grant: Novartis; Financial Interests, Institutional, Research Grant: BMS; Financial Interests, Institutional, Research Grant: NanoString; Financial Interests, Institutional, Advisory Board: BMS; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Advisory Board: Roche; Financial Interests, Institutional, Advisory Board: Novartis; Financial Interests, Institutional, Advisory Board: GlaxoSmithKline; Financial Interests, Institutional, Advisory Board: AstraZeneca; Financial Interests, Institutional, Advisory Board: Pfizer; Financial Interests, Institutional, Advisory Board: Lilly; Financial Interests, Personal, Stocks/Shares: Uniti Cars; Financial Interests, Personal, Stocks/Shares: Neon Therapeutics; Financial Interests, Personal, Stocks/Shares: Forty Seven; Financial Interests, Institutional, Advisory Board: Genmab; Financial Interests, Personal, Stocks/Shares: Immagene. M. Aarts: Financial Interests, Institutional, Advisory Board: Amgen; Financial Interests, Institutional, Advisory Board: BMS; Financial Interests, Institutional, Advisory Board: Novartis; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Advisory Board: Merck-Pfizer; Financial Interests, Institutional, Advisory Board: Pierre Fabre; Financial Interests, Institutional, Advisory Board: Sanofi; Financial Interests, Institutional, Advisory Board: Astellas; Financial Interests, Institutional, Advisory Board: Bayer; Financial Interests, Institutional, Research Grant: Merck-Pfizer. J.W.B. de Groot: Non-Financial Interests, Personal, Advisory Role: Novartis; Non-Financial Interests, Personal, Advisory Role: Bristol-Myers Squibb; Non-Financial Interests, Personal, Advisory Role: Pierre Fabre; Non-Financial Interests, Personal, Advisory Role: Servier; Non-Financial Interests, Personal, Advisory Role: MSD. G.A. Hospers: Non-Financial Interests, Institutional, Advisory Board: Amgen; Non-Financial Interests, Institutional, Advisory Board: BMS; Non-Financial Interests, Institutional, Advisory Board: Roche; Non-Financial Interests, Institutional, Advisory Board: MSD; Non-Financial Interests, Institutional, Advisory Board: Pfizer; Non-Financial Interests, Institutional, Advisory Board: Novartis; Non-Financial Interests, Institutional, Research Grant: BMS; Non-Financial Interests, Institutional, Research Grant: Seerave. E. Kapiteijn: Financial Interests, Institutional, Advisory Role: Amgen; Financial Interests, Institutional, Advisory Role: BMS; Financial Interests, Institutional, Advisory Role: Novartis; Financial Interests, Institutional, Advisory Role: Merck; Financial Interests, Institutional, Advisory Role: Pierre Fabre; Financial Interests, Institutional, Research Grant: BMS. A.A.M. Van der Veldt: Non-Financial Interests, Institutional, Advisory Role: BMS; Non-Financial Interests, Institutional, Advisory Role: MSD; Non-Financial Interests, Institutional, Advisory Role: Roche; Non-Financial Interests, Institutional, Advisory Role: Novartis; Non-Financial Interests, Institutional, Advisory Role: Pierre Fabre; Non-Financial Interests, Institutional, Advisory Role: Pfizer; Non-Financial Interests, Institutional, Advisory Role: Sanofi; Non-Financial Interests, Institutional, Advisory Role: Ipsen; Non-Financial Interests, Institutional, Advisory Role: Eisai. M. Boers-Sonderen: Non-Financial Interests, Institutional, Advisory Role: Pierre Fabre; Non-Financial Interests, Institutional, Advisory Role: MSD; Non-Financial Interests, Institutional, Advisory Role: Novartis. K. Suijkerbuijk: Non-Financial Interests, Institutional, Advisory Board: BMS; Non-Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Royalties: Novartis; Financial Interests, Institutional, Royalties: Pierre Fabre; Financial Interests, Institutional, Royalties: Roche. All other authors have declared no conflicts of interest.