Collin M Costello, Maria L Wei, James Isaacs, Elizabeth M Gaughan, Adina Greene, Alexandra So, Xiaochen Zhong, Jara Majuelos-Melguizo, Kavita Gandhi, Claudia Rey, Alicia Delibes, Rosemarie Barnett, Mizuho Fukunaga-Kalabis, Nawab Qizilbash, Irene M Shui, Xiang-Lin Tan
In alignment with National Comprehensive Cancer Network (NCCN) guidelines, management of early stage cutaneous melanoma was predominantly surgical. Patients with higher disease stages received more LOTs, and some patients received up to four systemic drug therapies. This highlights a need for novel therapies and optimization of treatment sequences for high-risk early stage melanoma.
BACKGROUND: Early stage melanomas are clinically heterogeneous and real-world treatment patterns in early stage cutaneous melanoma are poorly characterized.
OBJECTIVE: The purpose of this study was to characterize real-world treatment patterns among patients with early stage cutaneous melanoma.
METHODS: A retrospective chart review was conducted at four US sites. Adult patients with histologically confirmed stage IB-IIC melanoma diagnosed between 1 January 2018 and 24 months before the start of data collection at each site (latest 3 July 2024) were included. Data on treatment patterns, recurrence, and lines of treatment (LOTs) were collected using a case report form (CRF). Treatment patterns were analyzed for specific sequences given within the same LOT. Chi-squared or Fisher's exact tests were used to assess associations.
RESULTS: Among 398 enrolled patients, 224 (56.3%) were stage IB, 84 (21.1%) IIA, 65 (16.3%) IIB, and 25 (6.3%) IIC. Overall, 366 (92.0%) received sentinel lymph node biopsy, 392 (98.5%) received surgery, 135 (33.9%) watchful waiting, 49 (12.3%) systemic drug therapy, and 10 (2.5%) radiotherapy. Radiotherapy and systemic drug therapy use was significantly greater in patients with higher stages or recurrence. The most frequent systemic drug therapies were anti-PD-1 (81.6%) and anti-CTLA-4 (30.6%). A total of 394 (99.0%) patients received at least one LOT. Almost all patients (99.5%) received surgery alone or in combination as the first LOT. Systemic drug therapy was included in most second LOTs (57.8%). Overall, 64 (16.1%) patients received ≥ 2 LOTs (stage IB 8.9%, IIA 22.7%, IIB 23.1%, IIC 40.0%) and 25 (6.3%) received ≥ 3 LOTs (stage IB 3.1%, IIA 7.2%, IIB 10.8%, IIC 20.0%).
CONCLUSIONS: In alignment with National Comprehensive Cancer Network (NCCN) guidelines, management of early stage cutaneous melanoma was predominantly surgical. Patients with higher disease stages received more LOTs, and some patients received up to four systemic drug therapies. This highlights a need for novel therapies and optimization of treatment sequences for high-risk early stage melanoma.