Melanoma mortality rate trend in an era of effective treatments: A retrospective study, 1975-2019.

Abstract

e21555 Background: Skin cancer is the most common cancer in the US. Among all skin cancer cases, melanoma represents only about 1%, but it causes most of the deaths due to skin cancer. Unfortunately, the incidence of melanoma has increased over the last three decades. In the past decade, new and effective therapies for melanoma have emerged, with FDA-approval of multiple checkpoint inhibitors (such as PD-1 inhibitors and CTLA4 inhibitors), and multiple tyrosine kinase inhibitors (TKIs) targeting v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutated melanoma. The aim of this study is to review mortality trends in melanoma since the FDA-approval of these agents. Methods: Long term age adjusted cutaneous Melanoma Mortality Rate (MMR) trends in the United States were reviewed and evaluated using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program from 1975 to 2019. The Annual Percent Change (APC) with 95% confidence interval (CI) and p-value has been used to report long term trends. APC has been calculated using Joinpoint regression. Results: The MMR was found to be increased during 1975-1988 (APC 1.65%; p < 0.01). No statistically significant change in MMR was seen during 1988-2013 (APC 0.01%; p = 0.85). MMR was significantly decreased during 2013-2017 (APC -6.24%, p < 0.01). No statistically significant decrease has been seen during 2017-2019 (APC -1.56%, p = 0.53); however, there is a downward trend. Conclusions: This SEER database retrospective review of MMR provides the insight into change in long term mortality trends for melanoma in the United States. During 1975-2019, the MMR first increased, then stabilized and then decreased. After introduction of checkpoint inhibitors in 2011 and TKIs in 2013, significant reduction in melanoma mortality rate (MMR) was seen during 2013-2017 in the United States, even in the setting of increasing melanoma incidence. This likely reflects a benefit from the availability of effective therapies in the last decade. These treatment options are now also approved for use in the adjuvant setting, primarily after 2017. It will be interesting to see if a further significant reduction in MMR will be seen. It may also be worthwhile to study real-world population trends in other cancers where similar treatments have been found to be effective in recent years.[Table: see text]