Background: The landscape of systemic therapy for advanced melanoma has been changing quickly, beginning in March 2011 with ipilimumab approval, followed by approvals of BRAF/MEK inhibitors, and in late 2014, the anti-programmed death 1 (PD1) agents, pembrolizumab and nivolumab. This retrospective observational study examined the evolution of contemporary treatment patterns for metastatic melanoma (mMel, stage IV). Methods: We utilized electronic health records (EHR) from a national sample of US community practices in the Flatiron Health oncology database. Eligible patients were ≥ 18 years old and initiated first-line (1L) therapy for mMel from 1/1/2013, to 3/31/2015. Additionally, we studied patients with mMel prescribed pembrolizumab from 9/1/2014, and those prescribed nivolumab from 12/1/2014, through 8/31/2015. The three cohorts were followed through 9/30/2015. Results: The main cohort included 726 patients with mMel, of median age 66 years and 67% male. Of 695 (96%) tumors tested for BRAF mutation, 45% were BRAF mutant, 53% BRAF wild-type, and 2% indeterminate. Forty 1L regimens were administered, the most common being ipilimumab (49%) and vemurafenib (17%). The most commonly prescribed 2L regimens were pembrolizumab (22%), ipilimumab (19%), dabrafenib plus trametinib (15%), and nivolumab (10%). Treatment regimens changed dramatically after 3Q2014. For 1L, ipilimumab-based and BRAF inhibitor regimens were administered less frequently in both BRAF-mutant and BRAF wild-type cohorts, of whom 45% and 60%, respectively, received an anti-PD1 agent in 3Q2015. For 2L, use of anti-PD1 agents increased to 59% in 3Q2015, while ipilimumab use fell from 30% in 3Q2014 to 11% in 3Q2015. In the anti-PD1 cohorts, pembrolizumab was prescribed in 1L (60/161; 37%), 2L (46%), and 3L or later (17%), likewise nivolumab (39/102 [38%], 31%; 30%, respectively), both most commonly prescribed as monotherapy. Conclusions: Our study results illustrate the rapidly changing landscape of therapy for mMel. The immediacy of information provided by EHR-based datasets enables the study of current treatment patterns to guide future decisions about optimal therapies for mMel.
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ASCO Annual Meeting