(B-013) Treatment Patterns on Early-Stage Melanoma: Results from a Multi-site Chart Review

Background:
Early-stage melanomas are clinically heterogeneous. A subset of these patients is at high-risk of disease recurrence and poor outcomes. Understanding real-world treatment patterns is crucial to improve patient management and outcomes.

Objectives:
To describe treatment patterns for early-stage melanoma, in real-world clinical practice.

Methods:
A retrospective chart review was conducted in 4 US sites. Adult patients with histologically confirmed Stage IB, IIA, IIB, or IIC melanoma newly diagnosed between 1 January 2018 and 24 months before the start of data collection were included. Treatments including surgery, watchful waiting (WW), radiotherapy (RT) and systemic drug therapy (SDT) in any treatment line were described by counts and percentages, and before and after recurrence. Treatment patterns were analysed for specific sequence of treatment (alone or in combination), given within the same line of treatment. Chi-square or Fisher's exact tests were used to compare associations using 2-sided alpha level of 0.05.

Results:
Among 398 eligible enrolled patients, 224 (56.3%) were Stage IB, 84 (21.1%) IIA, 65 (16.3%) IIB, and 25 (6.3%) IIC. Overall, 392 (98.5%) patients received surgery, 135 (33.9%) WW, 49 (12.5%) SDT and 10 (2.5%) RT. RT and SDT use was significantly greater in patients with higher disease stages and recurrent patients. RT/SDT were employed in 1.3%/4.9% of Stage IB, 2.4%/15.5% of IIA, 3.1%/23.1% of IIB and 12.0%/40.0% of IIC patients. RT/SDT were also administered significantly more often at/after recurrence in recurrent patients compared to non-recurrent patients (66.1% vs 0.6% for SDT, and 15.3% vs 0.3% for RT). The most frequent SDT was anti-PD1 therapy (81.6%).
394 (99.0%) patients received at least one line of treatment: 99.5% received surgery alone or in combination as the first-line treatment. Overall, 64 (16.2%) patients received more than one lines of treatment (Stage IB (8.9%), IIA (22.7%), IIB (23.1%), IIC (40.0%)). SDT (alone or in combination) was included in 57.8% of the second-line treatment. Overall, 25 (6.3%) patients received three or more lines of treatment (Stage IB (3.1%), IIA (7.2%), IIB (10.8%), IIC (20%)).

Conclusions:
In early-stage melanoma, the use of RT and SDT increased in patients with higher disease stage and/or in patients who experienced recurrence. Patients with higher disease stage also tended to receive more lines of treatment. SDTs were used more often in second-line treatment and the most common SDT was anti-PD-1 therapy. These data offer insights into early-stage melanoma management and treatment patterns in relation to stage and recurrence risk.