Survival outcomes of patients with advanced melanoma from 2013 to 2017: Results of a nationwide population-based registry. (February 2021)

• Record Type: Journal Article
• Authors: van Zeijl, M.C.T.; de Wreede, L.C.; van den Eertwegh, A.J.M.; Wouters, M.W.J.M.; Jochems, A.; Schouwenburg, M.G.; Aarts, M.J.B.; van Akkooi, A.C.J.; van den Berkmortel, F.W.P.J.; de Groot, J.W.B.; Hospers, G.A.P.; Kapiteijn, E.; Piersma, D.; van Rijn, R.S.; Suijkerbuijk, K.P.M.; ten Tije, A.J.; van der Veldt, A.A.M.; Vreugdenhil, G.; van der Hoeven, J.J.M.; Haanen, J.B.A.G.
• Is Part Of: European journal of cancer. Volume 144(2021)
• Page Start: 242
• Page End: 251
• Publication Date: 2021-02
• Subjects: Advanced melanoma -- Immunotherapy -- Targeted therapy -- Real-world -- Nationwide -- Population-based; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2020.11.028
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: The treatment landscape has completely changed for advanced melanoma. We report survival outcomes and the differential impact of prognostic factors over time in daily clinical practice. Methods: From a Dutch nationwide population-based registry, patients with advanced melanoma diagnosed from 2013 to 2017 were analysed (n = 3616). Because the proportional hazards assumption was violated, a multivariable Cox model restricted to the first 6 months and a multivariable landmark Cox model from 6 to 48 months were used to assess overall survival (OS) of cases without missing values. The 2017 cohort was excluded from this analysis because of the short follow-up time. Results: Median OS of the 2013 and 2016 cohort was 11.7 months (95% confidence interval [CI]: 10.4–13.5) and 17.7 months (95% CI: 14.9–19.8), respectively. Compared with the 2013 cohort, the 2016 cohort had superior survival in the Cox model from 0 to 6 months (hazard ratio [HR] = 0.55 [95% CI: 0.43–0.72]) and in the Cox model from 6 to 48 months (HR = 0.68 [95% CI: 0.57–0.83]). Elevated lactate dehydrogenase levels, distant metastases in ≥3 organ sites, brain and liver metastasis and Eastern Cooperative Oncology Group performance score of ≥1 had stronger association with inferior survival from 0 to 6 months than from 6 to 48 months. BRAF-mutated melanoma had superior survival in the first 6 months (HR = 0.50 [95% CI: 0.42–0.59]). Conclusion(s): Prognosis for advanced melanoma in the Netherlands has improved from 2013 to 2016. Prognostic importance of most evaluated factors was higher in the first 6 months after diagnosis. BRAF-mutated melanoma was only associated with superior survival in the first 6 months. Highlights: Overall survival of patients with advanced melanoma improved from 2013 to 2016. Most prognostic factors had the highest impact on survival in the first 6 months. Over one-third patients with advanced melanoma had brain metastases and/or Eastern Cooperative Oncology Group performance score of ≥2. Treatment completely shifted to anti-PD-1, BRAFi plus MEKi and ipilimumab plus nivolumab.