OBJECTIVES: This analysis summarizes treatment patterns in real world settings among patients participating in the IMAGE study in European countries.   METHODS: IMAGE is an observational, multinational, prospective study focusing on treatment of patients with advanced melanoma.  Treatment may include ipilimumab or any other approved treatment (non-ipilimumab).  As of March 24, 2015, IMAGE included 1280 patients in North America, South America, Europe, Australia, and Israel.  A sub-analysis of patients from 9 European countries (N =1004) was conducted to better understand treatment initiation, prior and subsequent therapies, and treatment discontinuations. RESULTS: Of all 1004 patients, 96.4% had Stage IV melanoma upon enrollment.  Among the enrolled patients, 821 initiated the study on ipilimumab and remained on ipilimumab (ipilimumab only), and 30 initiated the study on non-ipilimumab and received ipilimumab during the study follow up (all ipilimumab).  Meanwhile, 153 initiated the study on non-ipilimumab therapy and remained on non-ipilimumab therapy during the study period (non-ipilimumab only) and 183 non–ipilimumab patients switched to ipilimumab.  Among all ipilimumab patients, 31.8% (n= 271) discontinued treatment early.  The main reasons for discontinuation were disease progression (n=94), drug toxicity (n=86), and death (n=55).  Among non-ipilimumab only patients, 39.2% (n=60), discontinued treatment early.  The main reasons for discontinuation were disease progression (n=18), drug toxicity (n=6), and non-drug related adverse events (n=6).  Among ipilimumab only patients, the most common last observed prior single agent therapies were dacarbazine (50.1%) and vemurafenib (25.5%).  Among all ipilimumab patients, 12.5% (n= 106) had subsequent therapy; 72.6% (n= 77) had one subsequent therapy, 19.8% (n=21) had two, and 8.4% (n= 8) had three or four. CONCLUSIONS: Most patients initiated treatment with ipilimumab.  The majority of patients who initiated treatment with ipilimumab stayed on ipilimumab, and most of those who discontinued treatment did so because of disease progression. Analyses will be updated as data mature.