Real-world results of first-line immunotherapy or targeted therapy for metastatic melanoma in Finland: a cohort study
Creators: name: Mattila, Kalle E
name: Tiainen, Leena
name: Vikkula, Johanna
name: Kreutzman, Anna
name: Engström-Risku, Mia
name: Kysenius, Kai
name: Hölsä, Olivia
name: Hernesniemi, Sari
name: Hemmilä, Päivikki
name: Pystynen, Anssi
name: Mäkelä, Siru
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Pharmacology
subject: Chemical Sciences not elsewhere classified
subject: Immunology
subject: FOS: Clinical medicine
subject: Cancer
subject: Mental Health

description: <b>Aim:</b> First-line (1L) immunotherapy has yielded superior overall survival (OS) in metastatic melanoma (MM) but some patients are ineligible for immunotherapy or need rapid response with 1L targeted therapy (TT). <b>Materials &amp; methods:</b> Retrospective cohort study of real-world patients treated with 1L immunotherapy (144 <i>BRAF</i> wild type, 85 <i>BRAF</i>-mutated) or 1L TT (143 <i>BRAF</i>-mutated) for MM in Finland during 2014–2021. <b>Results:</b> Baseline brain metastases, liver metastases and elevated LDH were less common, 2-year OS rates were higher (60.3–63.5% vs. 33.8%) and more patients were alive without the next-line treatment (38.0–43.8% vs. 23.3%) in patients with 1L immunotherapy. <b>Conclusion:</b> Real-world patients with 1L immunotherapy for MM had favorable baseline characteristics and better treatment outcomes than observed in patients with 1L TT. <b>Real-world results of immunotherapy or targeted therapy as the first treatment option for metastatic melanoma in Finland:</b> During the last ten years, immunotherapy and targeted therapy have improved the survival of patients with metastatic melanoma. We have studied 372 patients who had received immunotherapy or targeted therapy as the first treatment option for metastatic melanoma in Finland during 2014–2021. We found that the patients treated with immunotherapy had smaller disease burden and less commonly liver and brain metastases than the patients treated with targeted therapy. This could partly explain longer time to next treatment and longer survival achieved with immunotherapy. Over 40% of all patients received next treatment after the first treatment failed to keep their disease under control. These patients need urgently new treatment options. In Finland, real-world patients treated with 1L immunotherapy for metastatic melanoma had smaller disease burden and less commonly liver metastases, brain metastases, or elevated LDH compared with patients treated with 1L targeted therapy. The proportion of patients who had received any 2L treatment was 34.0% (<i>BRAF</i> wild type 1L immunotherapy), 58.8% (<i>BRAF</i>-mutated 1L immunotherapy) and 38.5% (<i>BRAF</i>-mutated 1L targeted therapy). In patients with <i>BRAF</i>-mutated metastatic melanoma treated with 1L immunotherapy, 84.0% of the patients who had received any 2L treatment had received targeted therapy with BRAF and MEK inhibitors. In patients with <i>BRAF</i>-mutated metastatic melanoma treated with 1L targeted therapy, only 45.5% of the patients who had received any 2L treatment had received immunotherapy with immune checkpoint inhibitors. The 2-year event-free survival rates (time to next treatment) were 43.8% (<i>BRAF</i> wild type 1L immunotherapy), 38.0% (<i>BRAF</i>-mutated 1L immunotherapy) and 23.3% (<i>BRAF</i>-mutated 1L targeted therapy). The 2-year OS rates were 60.3% (<i>BRAF</i> wild type 1L immunotherapy), 63.5% (<i>BRAF</i>-mutated 1L immunotherapy) and 33.8% (<i>BRAF</i>-mutated 1L targeted therapy).