Antonio Nakasato

Stage III melanoma incidence and impact of transitioning to the 8th AJCC staging system: a US population-based study

AIMnTo estimate incidence of stage III melanoma using the American Joint Committee on Cancer (AJCC) staging, 7th and 8th edition.nnnPATIENTS & METHODSnThe SEER US cancer registry was analyzed (2010-2014). AJCC7 stages were recorded in the data; AJCC8 stages were inferred.nnnRESULTSnOf 106,195 melanoma patients, 7669 and 7342 had stage III melanoma by AJCC7 and AJCC8, respectively (95% overlap). Nearly 30% of patients with AJCC7 stage III melanoma were reclassified in a higher stage III group by AJCC8 versus 7% in lower stage group. Regardless of the AJCC edition, incidence of stage III melanoma has increased from 2010 to 2014 both overall and within each stage III group.nnnCONCLUSIONnProviding appropriate management to this growing population of high-risk patients is a priority.

Healthcare resource utilization in patients with metastatic melanoma receiving first-line therapy with dabrafenib + trametinib versus nivolumab or pembrolizumab monotherapy

Abstract Objective: To compare healthcare resource utilization (HRU) between patients with metastatic melanoma (MM) initiated on first-line (1L) combination therapy with the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib (Du2009+u2009T; oral) and those initiated on 1u2009L monotherapy with the anti-PD1 monoclonal antibodies nivolumab or pembrolizumab (N/P; intravenous). Methods: Patients with melanoma initiated on Du2009+u2009T or N/P from Q1/2014 to Q2/2016 (defined as 1u2009L treatment for MM) were identified in the Truven MarketScan database. Entropy balancing was used to reweight the N/P cohort in order to make it comparable to the Du2009+u2009T cohort with respect to the mean and variance of baseline covariates. HRU outcomes during 1u2009L therapy, reported per patient-year (PPY), were described and compared between the two cohorts post-weighting (i.e. independently of baseline covariates). Results: Of the 445 patients included, 202 and 243 were initiated on Du2009+u2009T and N/P, respectively. After weighting, patients initiated on N/P had more outpatient visits for drug administration during 1u2009L therapy than those initiated on Du2009+u2009T (differenceu2009=u200918.6 visits PPY [95% CIu2009=u200916.0–21.1]). Patients initiated on N/P also had more outpatient office visits for reasons other than drug administration (differenceu2009=u20098.1 visits PPY [95% CIu2009=u20091.9–13.7]). No significant differences were observed for other HRU parameters (i.e. inpatient admissions, inpatient days, and emergency department visits during 1u2009L therapy). Conclusions: HRU during 1u2009L therapy was generally similar between patients initiated on Du2009+u2009T and N/P. Nonetheless, patients initiated on N/P had more outpatient visits, including more outpatient visits for reasons unrelated to drug administration.

Abstract 1209: Patterns of treatment with immune check point inhibitors and targeted therapy in patients with metastatic melanoma presumed BRAF V600 positive

Background: Immune check point inhibitors (I-O) and targeted therapies (TT) have changed the treatment landscape for patients with metastatic melanoma (MM), particularly for patients with BRAFV600 (BRAF) mutation who are eligible for both types of treatment after a diagnosis of MM. The aim of the current study was to describe patterns of treatment with I-O and TT in first line (1L) and subsequent lines of therapy for MM in a sample of patients presumed BRAF positive. Methods: Adults with MM initiated on I-O (ipilimumab, pembrolizumab, nivolumab) and TT (vemurafenib, dabrafenib, trametinib) therapies in 1L were identified in Symphony Health Solutions9 Integrated Dataverse (Q1/2014 - Q1/2017; n = 4,196), the largest pharmacy database in the US. Lines of pharmacological therapy were investigated from the first I-O/TT (index date) until the end of the observation period using an algorithm that relies on prescription/administration dates, days of supply and periods without any therapies. Patients were presumed BRAF positive if they received TT in at least one line of MM therapy. All patients in this analysis were required to have ≥ 2 lines of therapy for MM. Results: Of 366 presumed BRAF patients in the study sample, 110 (30%) and 256 (70%) were initiated on I-O and TT in 1L, respectively. The table below presents treatment patterns in 1L, 2L, and 3L for MM. The distribution of I-O vs TT was 30% vs. 70% in 1L, 25% vs. 57% in 2L, and 41% vs. 39% in 3L (table). Conclusions: This real-world data study showed dabrafenib+trametinib was the most common treatment for patients with MM presumed BRAF positive, even in the era of I-O availability. During the study period (years 2014-2017), ipilimumab continued to be the most common I-O therapy used in 1L and 2L among presumed BRAF patients. Citation Format: Sameer Ghate, Antonio Nakasato, Raluca Ionescu-Ittu, Sherry Shi, Briana Ndife, Rebecca Burne, Francois Laliberte, Mei Sheng Duh. Patterns of treatment with immune check point inhibitors and targeted therapy in patients with metastatic melanoma presumed BRAF V600 positive [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1209.