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Improved Progression-Free Long-Term Survival of a Nation-Wide Patient Population with Metastatic Melanoma

Authors
  • Soerensen, Anne Vest1
  • Ellebaek, Eva1
  • Bastholt, Lars
  • Schmidt, Henrik
  • Donia, Marco1, 2
  • Svane, Inge Marie1, 2
  • 1 (I.M.S.)
  • 2 National Center for Cancer Immune Therapy, Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 25C, 2730 Herlev, Denmark
Type
Published Article
Journal
Cancers
Publisher
MDPI AG
Publication Date
Sep 11, 2020
Volume
12
Issue
9
Identifiers
DOI: 10.3390/cancers12092591
PMID: 32932758
PMCID: PMC7564087
Source
PubMed Central
Keywords
License
Green

Abstract

Simple Summary New cancer treatments have prolonged the lives for patients with metastatic melanoma in clinical trials. However, patients in clinical trials often presents with a better prognosis than other patients. It is therefore important to examine the effect of the new treatments in a real-life setting. We found that survival for patients with metastatic melanoma in a nation-wide setting were prolonged and a higher proportion of these patients were alive and without active disease 3 years after they started treatment. Abstract Approval of immune checkpoint-inhibitors (ICIs) and BRAF-inhibitors has revolutionized the treatment of metastatic melanoma. Although these drugs have improved overall survival (OS) in clinical trials, real-world evidence for improved long-term survival is still scarce. Clinical data were extracted from the Danish Metastatic Melanoma database. This nation-wide cohort contains data on all patients who received systemic treatment for metastatic melanoma between 2008 and 2016. Ipilimumab, the first approved ICI, was implemented as standard-of-care in Denmark in 2012. Hence, patients were divided in a pre-ICI (2008–2011) and an ICI (2012–2016) era. Patients were defined as long-term survivors if they were alive 3 years after initiation of systemic therapy. Data from 1754 patients were retrieved. Patients treated in the ICI era had an improved median OS (11.3 months, 95% confidence interval (CI) 10.3–12.3) compared with those in the pre-ICI era (median OS 8.3 months, 95% CI 7.4–9.5, p < 0.0001). A higher proportion of long-term survivors was observed in the ICI era (survivors >3 years increased from 13% to 26% and survivors >5 years increased from 9% to 21%; both p < 0.0001). For long-term survivors, known prognostic factors were equally distributed between the two periods, except that long-term survivors in the pre-ICI era were younger. For long-term survivors, 70% were without progression in the ICI era compared with 43% in the pre-ICI era ( p < 0.0001). For all patients, the proportion without progression increased from 5% to 18% between the pre-ICI and the ICI era ( p < 0.0001), respectively. Implementation of ICI has led to a significant increase in progression-free, long-term survival for real-life patients with metastatic melanoma.

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