Abstract
Targeted therapies (TT) and immune checkpoint inhibitors (ICI) have become increasingly important in the treatment of metastatic malignant melanoma in recent years. We examined implementation and effectiveness of these new therapies over time in Germany with a focus on regional differences. We analyzed data from 12 clinical cancer registries in 8 federal states in Germany over the period 2000–2016. A total of 3871 patients with malignant melanoma in Union internationale contre le cancer (UICC) stage IV at primary diagnosis (synchronous metastases) or with metachronous metastases were included. We investigated differences in survival of patients treated with new and conventional therapies by log-rank tests for Kaplan–Meier curves. Cox regression models were estimated to adjust therapy effects for demographic, regional, and prognostic factors. New systemic therapies were increasingly applied throughout Germany. TT were most frequently documented in Eastern Germany (East: 11.2%; West: 6.3%), whereas ICI therapies were more frequently used in Western Germany (East: 1.7%; West: 3.9%). TT had a relevant influence on patient survival (hazard ratio (HR) = 0.831; 95%-CI = (0.729; 0.948)). Survival was worse in Eastern Germany (HR = 1.470; 95%-CI = (1.347; 1.604)) relative to Western Germany. Treatment and survival prospects of patients with melanoma differed considerably between Western and Eastern Germany. The differences in regional medication behavior and survival require further exploration.
Highlights
More than 80% of new malignant melanoma cases worldwide occur in Australia, New Zealand, North America, and Europe [1]
The occurrence of melanoma subtypes was reported in nearly the same order in both subgroups, but nodular melanoma (NM) were documented considerably more often in the Eastern Germany (East) German federal states
Patients from Eastern Germany had a 47% higher hazard of death compared to patients from Western Germany (HR = 1.470; 95%-CI = (1.347; 1.604))
Summary
More than 80% of new malignant melanoma cases worldwide occur in Australia, New Zealand, North America, and Europe [1]. It is the third most common cancer in Australia (age-standardized incidence rate 33.6 per 100,000, World Standard Population) and New Zealand (33.3 per 100,000), and the seventh most common cancer in North America (12.6 per 100,000) as well as in Europe In Germany, malignant melanoma is the sixth most common cancer (21.6 per 100,000) [1]. The absolute number of incident melanoma cases increased continuously between 1999 and 2017 [2]. Malignant melanoma can be treated with an exceptionally good prognosis if it is detected
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