Aims
This study aims to describe the characteristics and survival outcomes of melanoma patients treated with first line immunotherapy (IT), targeted therapy (TT), and chemotherapy (CT) in a Queensland tertiary hospital. We compare our findings to published randomised controlled trials (RCTs).
Methods
We retrospectively reviewed systemic therapies in non-trial melanoma patients at Princess Alexandra Hospital between 09/2009 and 03/2017. Patient and treatment data were extracted from the electronic oncology prescribing software (Charm®) and death data from the Queensland Cancer Register (QCR). We calculated Kaplan-Meier estimates of median overall survival (OS) and compared OS among treatment groups using the log-rank test. P-values <0.05 were considered statistically significant.
Results
938 patients received treatment for melanoma in the study period; 347 patients met the inclusion criteria. First-line therapy consisted of: IT 138 (40%) patients; TT 128 (37%) patients; CT 81 (23%) patients.
IT or TT first-line treatment significantly increased median OS compared to CT: IT 19.1 months, 95% CI 15.8, 29.3; TT 13.1 months, 95% CI 8.4, 16.1 vs. CT 5.2 months, 95% CI 4.4, 6.2 (P<0.0001). Two-year OS of IT was 48%, TT 29%, and CT 10%. Two-year OS for study group therapies were lower compared to matched RCTs.
Conclusions
Our results reflect the evolution of effective therapy for melanoma over the study period. Immunotherapies and targeted therapies were effective compared to chemotherapy, as measured by OS, in real-world patients. The lower 2-year OS results are likely due to clinical trial participant exclusion. Our cohort could be generally more frail and unwell, and our dataset did not contain comorbidity, performance status, or toxicity data to analyse. Despite such limitations, this study articulates the value of real-world evidence: enhancing the precise evidence generated by RCTs with the real effectiveness data from clinical practice. (1)