Abstract
Purpose: China has much lower 5-year survival rates among melanoma patients than Western countries. This retrospective study describes real-world clinical outcomes and prognostic factors in locally advanced/metastatic melanoma in China. Materials and methods: Adults patients with unresectable stage III or IV melanoma treated between January 1, 2014 and December 31, 2015, at the Beijing Cancer Hospital were eligible (data cutoff: December 31, 2017). The Kaplan-Meier method and Log-Rank test were used to estimate the median value of time-to-event outcomes. A Cox proportional hazards model was simulated to evaluate associations of patients’ characteristics with survival. Results: Overall, there were 221 and 116 Chinese locally advanced and/or metastatic melanoma patients were enrolled in the first line (1L) and the second line (2L) treatments, respectively. The real-world objective response rate was <10% (1L: 6.3%; 2L: 3.4%); median progression-free survival was under 4 months (1L: 3.5; 2L: 2.3); median overall survival (OS) was <1 year (1L: 10.5; 2L: 7.5) with a low 12-month OS rate (43.5% for 1L, 30.5% for 2L). Based on univariate analyses, those with Eastern Cooperative Oncology Group (ECOG) Performance Status ≥2 (vs. ECOG=0) in 1L, and 2L treatment (vs. 1L treatment) or ECOG ≥2 (vs. ECOG=1) among 1L/2L were associated with statistically significantly worse outcomes. Conclusion: The current clinical outcomes in advanced melanoma patients in China are poor. High ECOG performance score independently increase risk of death both from 1L and 2L treatments, suggesting a high unmet medical need for immunotherapy in advanced melanoma.
Highlights
China has much lower 5-year survival rates among melanoma patients than Western countries
There were 221 and 116 Chinese locally advanced and/or metastatic melanoma patients enrolled in 1.4% of first line (1L) and 2L treatments, respectively
The retrospective longitudinal, population-based China study aimed to demonstrate the importance and utility of potential covariates as prognostic factors for survival among patients with unresectable, locally advanced or metastatic melanoma during a chemotherapy-dominated era in China. We showed that those patients with Eastern Cooperative Oncology Group (ECOG) ≥ 2 had only one-third to one-half median overall survival (OS) and progression-free survival (PFS) compared with those with ECOG = 0
Summary
China has much lower 5-year survival rates among melanoma patients than Western countries. In our previous study among 248 Chinese locally advanced/ metastatic melanoma patients (95% stage IV; 40.7% acral and 30.6% mucosal histology), we reported that dacarbazine plus cisplatin plus rh-endostatin and paclitaxel plus carboplatin plus bevacizumab were the most used therapeutic regimens in the 1L setting, accounting for 36,7% and 22.2%, respectively. With those chemotherapeutic agents, the objective response rate (ORR) was 6.3% [95% confidence interval (CI), 3.5%–10.4%]; the median progression-free survival (PFS) and overall survival (OS) being 3.5 and 10.5 months, respectively. The paclitaxel albumin plus carboplatin plus bevacizumab; paclitaxel plus carboplatin plus Endostar and paclitaxel albumin plus cisplatin plus Endostar accounted for 22.4%, 15.5%, and 12.1% of 2L treated melanoma patients, resulting in overall ORR as 3.4% (95% CI, 0.9%–8.6%) and median of PFS and OS as 2.3 and 7.5 months, respectively
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