(314) Recent Real-World Treatment Patterns of Advanced Melanoma in the United States

Background: : Melanoma has a good prognosis if diagnosed at a localized stage. However, despite significant recent advances in therapy, treatments for patients with unresectable or metastatic melanoma are most often not curative.

Objective: : The objective of this study was to characterize recent real-world treatment patterns of advanced, unresectable melanoma patients who progress to second-line (2L) systemic treatment.

Methods: : Adults in a large administrative claims database between 1/2019 and 12/2024 were included in the analysis if they had ≥2 claims for melanoma ≥7 days apart, melanoma as the primary tumor, ≥1 code for a systemic melanoma treatment after 1/1/2023, and ≥1 code for metastatic disease and had progressed to 2L treatment. Included patients had ≥3 months of continuous enrollment before the index date (first melanoma claim). Claims-based algorithms were used to identify monotherapy/combination regimens by line of treatment (LOT). A Sankey diagram was constructed to illustrate the exact treatment pattern flows between LOT1 and LOT2.

Results: : A total of 1252 patients met study criteria and had progressed to a 2L regimen; 57% were male and the median age was 63.5 years. Among these patients, the most common first-line (1L) regimens were immune checkpoint inhibitors (ICIs; n=1029, 82.2%): pembrolizumab (n=386, 30.8%), nivolumab + ipilimumab (n=367, 29.3%), nivolumab + relatlimab (n=144, 11.5%), nivolumab (n=128, 10.2%), or other anti–PD-1 therapy (n=4, 0.3%). Other 1L treatments received were targeted therapy for BRAF V600 mutation (n=147, 11.7%), chemotherapy (n=28, 2.2%), or other regimens (n=48, 3.8%). After progression to 2L therapy, the treatments became more heterogeneous with decreased utilization of ICI therapy (n=795, 63.5%). The most common 2L therapies were targeted therapy for a BRAF V600 mutation (n=325, 26.0%), nivolumab + ipilimumab (n=240, 19.2%), nivolumab + relatlimab (n=193, 15.4%), nivolumab (n=178, 14.2%), pembrolizumab (n=178, 14.2%), chemotherapy (n=68, 5.4%), or other (n=70, 5.6%).

Conclusions: : Patients with advanced melanoma for whom 1L therapy fails have no clear standard of care as the 2L treatment landscape is heterogenous.

Sponsorship:: Replimune, Inc.