Demographics, Pattern of Care, and Outcome Analysis of Malignant Melanomas - Experience From a Tertiary Cancer Centre in India
| Autor: | Vijay Patil, Anant Ramaswamy, Bharat Rekhi, Vanita Noronha, Anshul Agarwal, Sujay Srinivas, Amrita Guha, Nehal Khanna, Siddharth Turkar, Akhil Kapoor, Avanish Saklani, Venkatesh Rangarajan, Jyoti Bajpai, Sudeep Gupta, Kumar Prabhash, Munita Bal, Prabhat Bhargava, Siddhartha Laskar, Jitender Rohila, Ashwin Desouza, George Abraham, Vikas Ostwal, Nandini Menon, Pradip Kumar Mondal, Rajiv Kumar, Prathyusha Eaga, Amit Joshi, Sashanka Das, Shripad Banavali, Ambarish Chatterjee, Arun Chandrasekharan, Sushmita Rath, Amit Janu |
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| Rok vydání: | 2021 |
| Předmět: |
Cancer Research
medicine.medical_specialty Multivariate analysis Anemia Paclitaxel-carboplatin-LD interferon regimen medicine.medical_treatment Immune checkpoint inhibitors malignant melanoma oral metronomic therapy chemotherapy LMICs BRAF immune checkpoint inhibitors Median follow-up Internal medicine medicine RC254-282 Original Research Patterns of care Chemotherapy business.industry Melanoma Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease Oncology Cohort business |
| Zdroj: | Frontiers in Oncology Frontiers in Oncology, Vol 11 (2021) |
| ISSN: | 2234-943X |
| Popis: | BackgroundTreatment of malignant melanoma has undergone a paradigm shift with the advent of immune checkpoint inhibitors (ICI) and targeted therapies. However, access to ICI is limited in low-middle income countries (LMICs).Patients and MethodsHistologically confirmed malignant melanoma cases registered from 2013 to 2019 were analysed for pattern of care, safety, and efficacy of systemic therapies (ST).ResultsThere were 659 patients with a median age of 53 (range 44–63) years; 58.9% were males; 55.2% were mucosal melanomas. Most common primary sites were extremities (36.6%) and anorectum (31.4%). Nearly 10.8% of the metastatic cohort were BRAF mutated. Among 368 non-metastatic patients (172 prior treated, 185 de novo, and 11 unresectable), with a median follow-up of 26 months (0–83 months), median EFS and OS were 29.5 (95% CI: 22–40) and 33.3 (95% CI: 29.5–41.2) months, respectively. In the metastatic cohort, with a median follow up of 24 (0–85) months, the median EFS for BSC was 3.1 (95% CI 1.9–4.8) months versus 3.98 (95% CI 3.2–4.7) months with any ST (HR: 0.69, 95% CI: 0.52–0.92; P = 0.011). The median OS was 3.9 (95% CI 3.3–6.4) months for BSC alone versus 12.0 (95% CI 10.5–15.1) months in any ST (HR: 0.38, 95% CI: 0.28–0.50; P < 0.001). The disease control rate was 51.55%. Commonest grade 3–4 toxicity was anemia with chemotherapy (9.5%) and ICI (8.8%). In multivariate analysis, any ST received had a better prognostic impact in the metastatic cohort.ConclusionsLarge real-world data reflects the treatment patterns adopted in LMIC for melanomas and poor access to expensive, standard of care therapies. Other systemic therapies provide meaningful clinical benefit and are worth exploring especially when the standard therapies are challenging to administer. |
| Databáze: | OpenAIRE |
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