Sharp declines in melanoma mortality 'unprecedented in cancer medicine'
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The introduction and approval of new treatments for metastatic melanoma has led to significant declines in population-level mortality over the past several years, according to results of a retrospective study published in American Journal of Public Health.
Researchers described the multiyear decrease in melanoma deaths — which had been rising for more than 2 decades — as “unprecedented in cancer medicine.”
“Before these new therapies, the standard treatment was chemotherapy, which was not effective,” David Polsky, MD, PhD, professor in the departments of dermatology and pathology and the Alfred W. Kopf, MD, professor of dermatologic oncology at NYU Langone Health, told Healio. “Basically, the tumors weren’t susceptible to any of the drugs being used to treat other forms of cancer.
“Very few patients survived more than a few years after the diagnosis of metastatic disease,” he added. “In fact, at academic centers, the standard of care for these patients was to go right to a clinical trial of a new therapy. Chemotherapy typically was used only after the experimental therapy didn’t work.”
Mortality rates for melanoma continued to rise throughout the 1990s and early 2000s, despite gradual declines in mortality rates for many other cancers, with older men being the most likely to die of the disease.
Since 2011, however, the FDA has approved 10 new treatments for metastatic melanoma. These include anti-CTLA-4 and anti-PD-1 drugs, as well as BRAF and MEK inhibitors and talimogene laherparepvac (Imlygic, Amgen), a herpes simplex virus-1-based oncolytic immunotherapy often referred to as T-VEC.
Polsky and colleagues analyzed melanoma incidence and mortality among whites — the population most affected by melanoma — between 1986 and 2016 to see whether the new treatments — six of which were approved between 2011 and 2014 — had an impact on population-level mortality data.
The analysis of data from the SEER database showed that, between 1986 and 2016, melanoma incidence rates among whites aged 20 years and older increased by 108% (annual percent change [APC], 2.7%; 95% CI, 2.5-2.9). Among those aged 50 years and older, incidence rates increased by 178.4% (APC, 3.4%; 95% CI, 3.2-3.7) for men and by 142.1% (APC, 3.2%; 95% CI, 3-3.5) for women.
Researchers reported a 7.5% increase in overall mortality rates between 1986 and 2013 (APC = 0.22%; 95% CI, 0.1-0.3). Between 2013 and 2016, however, overall mortality decreased by 17.9% (APC, 6.24%; 95% CI, 8.7 to 3.7). This included sharp declines among men aged 50 years and older (APC, 8.25%; 95% CI, 12.2 to 4.1) starting in 2014.
The multiyear decline, which coincides with the introduction of the new therapies, represents the sharpest and most sustained improvement in melanoma mortality ever, researchers wrote.
“Our findings show how quickly patients and physicians accepted these new drugs because they profoundly reduce [melanoma] deaths,” Polsky said in a press release. “These therapies are now considered the backbone of how we treat this cancer.”– by John DeRosier
For more information:
David Polsky, MD, PhD, can be reached at NYU Dermatologic Associates, 530 First Ave., Suite 7R, New York, NY 10016.
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