Treatment Patterns Of Metastatic Melanoma In Five European Countries.

To describe treatment patterns by BRAFstatus, stage, and line of therapy among patients with metastatic melanoma in five European countries. Patients with metastatic melanoma (stage IIIB-IV M1c) from France, Germany, Italy, Spain, and the UK were identified from the IMS Oncology Advantage Database that was collected from Q2 2014 to Q1 2015. Treatment patterns were examined by BRAFstatus, stage, and line of therapy in each country. The study included 2,532 patients with unresectable metastatic melanoma (50.0% BRAF mutated; 10.5% stage IIIB-IV M1a, 37.8% ≤ 55 years, 52.6% female). Monotherapy accounted for 94.9% of all drug therapies. In patients with BRAF mutated disease, vemurafenib was the most common first-line treatment in both stage IIIB-IV M1a and stage IV M1b-M1c (France: 63.0% and 61.4%, Germany: 65.2% and 56.3%, Italy: 88.9% and 75.0%, Spain: 38.1% and 52.8%, UK: 61.5% and 84.6%). In patients with BRAF wild-type disease, the most common first-line treatment in stage IIIB-IV M1a was ipilimumab in France (34.5%), Italy (38.9%), and the UK (76.5%), and dacarbazine in Germany (40.0%) and Spain(37.5%); while the most common first-line treatments in stage IV M1b-M1c were dacarbazine and ipilimumab in France (36.6% and 30.5%), Germany (31.3% and 40.7%), Italy (37.9% and 19.8%), and the UK (55.3% and 36.6%), and dacarbazine and fotemustine (44.9% and 17.7%) in Spain. In second-line, ipilimumab was the most commonly used agent regardless of BRAF status (BRAF mutated: 27.0%-85.7%, BRAFwild-type: 39.5%-90.9%). In the five Western European countries, the most commonly used first-line treatment for patients with BRAF mutated disease was vemurafenib in all stages; whereas dacarbazine and ipilimumab were most frequently used for patients with BRAF wild-type disease. The high prevalence of dacarbazine use, an older agent, suggests a need for more effective and less toxic treatments for patients with unresectable metastatic melanoma.