The survival in metastatic melanoma has dramatically improved after the introduction of immune checkpoint- (ICIs) and MAPKinase inhibitors (MAPKis).
Our aim was to describe therapy response and survival in a real-world population as well as assessing the associations between clinical variables and therapy outcome for patients with metastatic melanoma receiving first-line ICIs or MAPKis.
A total of 252 patients with metastatic melanoma were prospectively followed between January 1, 2010 and December 3, 2017 with follow-up until March 31, 2019, at the Karolinska University Hospital, Sweden. Hazard Ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were analyzed with Cox regression, and logistic regression was used to estimate odds ratios (ORs) for therapy response.
Patients receiving ICIs (n=138) experienced longer PFS compared to patients that received MAPKis (n=114) (median PFS for ICIs was 6.8 months, median PFS for MAPKis was 5.3 months). In the multivariable analyses of clinical markers, increasing M-stage (OR 0.65; 95% CI 0.45-0.94; p=0.022), and male sex (OR 0.41; 95% CI 0.19-0.90; p=0.027) were significantly associated with lower response to ICIs. Lower baseline albumin levels (OR 0.90; 95% CI 0.83-0.98; p=0.019) and male sex (OR 0.33; 95% CI 0.12-0.93; p=0.036) were related with lower response to MAPKis. For ICIs, increasing M-stage (HR 1.34; 95% CI 1.07-1.68; p=0.010), increasing LDH (HR 1.73; 95% CI 1.19-2.50; p=0.004), and decreasing albumin (HR 1.06; 95% CI 1.01-1.10; p=0.011) were significantly associated lower PFS in the adjusted model. The corresponding markers for MAPKis were increasing LDH (HR 1.44; 95% CI 1.08-1.92; p=0.013) and decreasing albumin (HR 1.05; 95% CI 1.02-1.09; p= 0.005) for PFS.
ICIs and MAPKis were effective in this real-world population and we could confirm the importance of previously reported clinical prognostic markers. Albumin values may be associated with therapy outcome but needs further validation.

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