(326) Real-world treatment patterns, costs, and burden of illness in advanced or unresectable cutaneous melanoma following discontinuation of frontline PD-1 inhibitor therapy: A claims database analysis

Background: : Several programmed cell death protein-1 (PD-1) inhibitor agents and combination regimens have been approved as frontline (1L) therapies for advanced or unresectable melanoma; however, treatment with these therapies in 1L is most often not curative. Despite approved therapies, there is no established standard of care for these patients (pts) after disease progression on anti–PD-1 agents.

Objective: : This study examined the real-world treatment patterns and cost burden of commercial insurance enrollees with advanced or unresectable melanoma who discontinued 1L anti–PD-1 therapies.

Methods: : A retrospective claims analysis was conducted including adult pts with ≥2 primary codes for melanoma ≥30 days apart, occurring between 1/1/2021 and 12/31/2024. Pts had no melanoma diagnoses 2 years prior to the first diagnosis and had ≥1 healthcare claim per month. Pts were required to have initiated and subsequently discontinued 1L anti–PD-1 therapy (monotherapy or combination). The index date for this analysis was the start of subsequent second-line (2L) systemic treatment. Pts were followed until the end of treatment, death, or end of follow-up. Treatment patterns, healthcare reimbursement costs per-treated-member-per-month (PTMPM) and durations of therapy (DOTs) were calculated by line of therapy.

Results: : A total of 15,436 pts were diagnosed with advanced melanoma between 1/1/2021 and 12/31/2024 and received a 1L anti–PD-1 therapy; 59% of pts were male, and the median age was 67 years. Overall, 10.8% (n=1662) of 1L pts progressed to a 2L systemic treatment (72.1% [n=1198] anti–PD-1 agent or combination, 17.9% [n=298] BRAK/MEK–targeted therapy, 10.0% [n=166] other), and 17.0% (n=283) of 2L pts received subsequent third-line (3L) therapy (67.8% [n=192] anti–PD-1 agent or combination, 17.7% [n=50] BRAK/MEK–targeted therapy, 14.5% [n=41] other). Total costs PTMPM for 1L, 2L, and 3L were $19,317, $30,803, and $59,503, respectively. DOTs by line were 11.2, 5.8 and 6.5 months for 1L, 2L, and 3L, respectively.

Conclusions: : These findings show that monthly treatment costs for these pts rise substantially with each line of therapy, while treatment durations decline. This negative correlation suggests that later-line therapies are more expensive on a monthly basis while providing limited durability, leading to higher costs for less benefit. These results suggest a need for novel, more effective treatment options for pts with melanoma who experience disease progression after anti–PD-1 therapy.

Sponsorship:: Replimune, Inc.