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. 2017 Oct;143(10):2087-2094.
doi: 10.1007/s00432-017-2453-z. Epub 2017 Jun 12.

Survival of melanoma patients treated with novel drugs: retrospective analysis of real-world data

Marta Polkowska  1   2 , Paweł Ekk-Cierniakowski  3   4 , Edyta Czepielewska  5 , Wojciech Wysoczański  3 , Wojciech Matusewicz  3 , Małgorzata Kozłowska-Wojciechowska  5
Affiliations

Survival of melanoma patients treated with novel drugs: retrospective analysis of real-world data

Marta Polkowska et al. J Cancer Res Clin Oncol. 2017 Oct.

Abstract

Purpose: Recently, several new drugs have been licensed for advanced melanoma therapy, significantly changing the therapeutic landscape. Ipilimumab and vemurafenib were the first drugs that demonstrated a survival benefit over the long-standing standard therapy with dacarbazine. However, the comparative efficacy of these novel drugs has not been properly assessed yet.

Patients and methods: We conducted a retrospective analysis of all the Polish population treated between January 2012 and October 2016 with one of the following agents: ipilimumab (IPI), vemurafenib (VEM), dabrafenib (DAB), and classic chemotherapy (CTH). The main objective was to assess the overall survival of melanoma patients treated in real-world conditions, taking into account sequences of treatment.

Results: We identified 3397 patients with malignant melanoma treated for the first line and the second line. Patients receiving CTH were significantly older than those treated with the novel drugs. At the same time, the population treated with immunotherapy and targeted therapy was well balanced. Overall survival was significantly better for the novel drugs compared to classic chemotherapy in both lines (for the first line, VEM vs CTH HR = 0.72, 95% CI 0.65-0.81; p < .01, and for the second line, VEM vs CTH HR = 0.78, 95% CI 0.62-0.98; p = .03; IPI vs CTH HR = 0.72, 95% CI 0.62-0.86; p < .01). There was no statistically significant difference for IPI vs VEM; however, subgroup analysis revealed superior results in the case of the CTH-IPI over BRAFi-IPI sequence.

Conclusion: Novel drugs for melanoma provide a significant advantage in survival over classic chemotherapy. Comparative assessment of IPI and VEM indicated no difference, but only immunotherapy-treated patients achieved long-lasting results. Our data on sequential treatment indicate that immunotherapy might be a better option for the first line rather than targeted therapy, but that conclusion requires further studies of the best way to manage the treatment of melanoma patients.

Keywords: Immunotherapy; Malignant melanoma; Overall survival; Real-world data; Targeted therapy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier estimation of survival a in the first line b in the second line. VEM vemurafenib, DAB dabrafenib, IPI ipilimumab, CTH chemotherapy
Fig. 2
Fig. 2
Kaplan–Meier estimation of survival in the second line–subgroup analysis based on the previous agents. BRAFi BRAF inhibitor, VEM vemurafenib, IPI ipilimumab, CTH chemotherapy
See this image and copyright information in PMC

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