Since 2011 the treatment paradigm for metastatic melanoma has dramatically changed, with the availability of immunotherapy and targeted therapies. Phase III trial results have shown a dramatic improvement in survival. Real-world survival data is required to support our use of expensive treatment options. We report the survival of all non-trial patients treated for metastatic melanoma at two tertiary referral centres in Western Australia since 2009.
All patients with metastatic melanoma treated at Royal Perth Hospital and Fiona Stanley Hospital between 2009 and 2016 were identified. Two cohorts were formed according to start of treatment, before or after the 1st January 2013. Kaplan Meier estimates are used to demonstrate survival.
From 1st January 2009 to 31st December 2016, 132 patients commenced treatment for metastatic melanoma. Forty-five patients began treatment before 1st January 2013 and eighty-seven after. The median age was 66.3 years and 64.8 years respectably, with a male predominance 60% (27) and 72% (63). BRAF mutation status was tested in 88 patients; 58% were mutated. Pre-2013, 84% received Dacarbazine first-line, with 4 patients receiving Ipilimumab and 3 patients receiving Vemurafenib. Post-2012, equal numbers of patients received targeted therapies (48.2%) and immunotherapies (48.2%). The median overall survival was 6.9 months pre-2013 and 12 months post-2012 (p<0.04), with a hazard ratio of 1.77 (p<0.02). The median survival of those who received targeted therapies was 12.7 months, 12.3 months for immunotherapy, and 5.8 months for chemotherapy (p<0.13).
Immunotherapy and targeted therapies demonstrate a significant improvement in survival in a real-world population outside of clinical trials. Further data is required to determine the optimal sequencing of therapies.