TREATMENT PATTERNS AND GAPS IN RESECTABLE MUCOSAL MELANOMA CARE FOR MEDICARE BENEFICIARIES IN THE UNITED STATES
Author(s)
Onur Baser, MA, MS, PhD1, Marjan Zakeri, MD, PhD2, Xianxin Zhu, MS3, Sam Wagner, MPharm, PhD2.
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA, 3Columbia Data Analytics, Ann Arbor, MI, USA.
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA, 3Columbia Data Analytics, Ann Arbor, MI, USA.
OBJECTIVES: Mucosal melanoma (MM) is a rare but aggressive subtype of melanoma. Due to nonspecific symptoms and challenging anatomical locations, MM is often diagnosed at advanced stages. While surgery has traditionally been the primary curative modality, the emergence of immune checkpoint inhibitors has offered new therapeutic options. However, the application of these treatments among older populations is not well described. This study aimed to assess real-world treatment patterns for resectable MM among US adults aged ≥65 years.
METHODS: Medicare beneficiaries aged ≥65 years diagnosed with resectable MM (localized/regional lymph node involved) between 01JAN2014-31DEC2021 were identified using Surveillance, Epidemiology, and End Results (SEER) registry dataset. Six months continuous health plan enrollment at baseline was required. Patient data were examined for 2 years. Treatments included surgery, immunotherapy (e.g. PD-1 and PD-L1 inhibitors), chemotherapy (e.g. dacarbazine, temozolomide), and targeted therapies (e.g. kinase inhibitors). Descriptive analysis evaluated use of surgery, adjuvant systemic therapy (<90 days after surgery), and systemic therapy (≥ 90 days after surgery).
RESULTS: Overall, 599 patients were identified with a resectable tumor; of those 66.6% received curative surgery. Among those who underwent surgery, 48.1% received adjuvant systemic therapy, and 30.1% initiated systemic therapy. Among patients with adjuvant therapy, the most common treatment was PD-1/PD-L1± ipilimumab (51%), followed by ipilimumab monotherapy (23.4%). Among those who received systemic therapy as the first line of treatment, 50% received PD-1/PD-L1± ipilimumab followed by chemotherapy (15%) and targeted therapy (15%). Among patients who did not receive surgery, 60% received systemic therapy with the most common treatment being PD-1/PD-L1± ipilimumab (50%).
CONCLUSIONS: The study found substantial gaps in the receipt of evidence-based surgical and systemic therapies among older adults diagnosed with resectable MM. These results underscore the continued need for efforts to optimize real-world care and bridge the gap between clinical guidelines and delivered treatment for these patients.
METHODS: Medicare beneficiaries aged ≥65 years diagnosed with resectable MM (localized/regional lymph node involved) between 01JAN2014-31DEC2021 were identified using Surveillance, Epidemiology, and End Results (SEER) registry dataset. Six months continuous health plan enrollment at baseline was required. Patient data were examined for 2 years. Treatments included surgery, immunotherapy (e.g. PD-1 and PD-L1 inhibitors), chemotherapy (e.g. dacarbazine, temozolomide), and targeted therapies (e.g. kinase inhibitors). Descriptive analysis evaluated use of surgery, adjuvant systemic therapy (<90 days after surgery), and systemic therapy (≥ 90 days after surgery).
RESULTS: Overall, 599 patients were identified with a resectable tumor; of those 66.6% received curative surgery. Among those who underwent surgery, 48.1% received adjuvant systemic therapy, and 30.1% initiated systemic therapy. Among patients with adjuvant therapy, the most common treatment was PD-1/PD-L1± ipilimumab (51%), followed by ipilimumab monotherapy (23.4%). Among those who received systemic therapy as the first line of treatment, 50% received PD-1/PD-L1± ipilimumab followed by chemotherapy (15%) and targeted therapy (15%). Among patients who did not receive surgery, 60% received systemic therapy with the most common treatment being PD-1/PD-L1± ipilimumab (50%).
CONCLUSIONS: The study found substantial gaps in the receipt of evidence-based surgical and systemic therapies among older adults diagnosed with resectable MM. These results underscore the continued need for efforts to optimize real-world care and bridge the gap between clinical guidelines and delivered treatment for these patients.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO186
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
SDC: Oncology, STA: Surgery