DETERMINANTS OF INITIAL TREATMENT FOR ADVANCED MELANOMA

We recently described treatment (tx) patterns in a representative real-world cohort of U.S. patients (pts) diagnosed with unresectable or metastatic melanoma (advanced melanoma [AM]) and found 70 unique regimens observed in 689 treated pts (Macahilig 2011). OBJECTIVES: To investigate if there is an association between tx choice and patient or practice characteristic(s) in AM. METHODS: Data from a random sample of 752 medical charts of newly diagnosed AM pts (2004-2008) from 113 US oncologists were collected. In analyses of the 689 pts receiving anti-cancer tx, we examined pt characteristics of 2 tx categories: pts receiving temozolomide (Tmz) (the most frequently prescribed tx) and those not receiving Tmz (“other”). Significance was defined as P<0.05.  RESULTS: In first-line (FL) tx, pts receiving Tmz were significantly more likely to be male and have significantly poorer prognostic characteristics including ECOG PS ≥2 (41% vs. 27%); distant disease (85% vs. 68%); more metastatic sites (1.9 vs. 1.6); brain metastases (26% vs. 15%); elevated LDH (61% vs. 52%); and age ≥65 (58% vs. 41%) compared to the “other” group. FL Tmz pts were also significantly more likely to have public primary medical insurance (58% vs. 45%). There was no statistical difference in FL use of Tmz versus “other” tx in academic versus community practice settings or by physician melanoma caseload.  CONCLUSIONS: The current study provides evidence that tx choice in AM is associated at least in part with pt characteristics.