title: Clinical use of ipilimumab for metastatic melanoma in Spain: towards a more consistent approach.
abstract: BACKGROUND
  Ipilimumab has been approved in patients with advanced melanoma by different regulatory bodies worldwide, but its use in clinical practice is not fully consistent among oncologists. We have surveyed a representative sample of Spanish medical oncologists on issues related to the use of ipilimumab.
  
  
  METHODS
  The survey was based on the Delphi method, where experts respond anonymously to two rounds of a questionnaire. Questionnaire consisted of 42 statements divided among the following eight categories: Pathology and Diagnosis; Patterns of Response; Parameters affecting Treatment Selection; Patient Profile; Sequencing of Treatment; Definition of Long-Term Survivors; Quality of Life; Concept of Immuno-oncology. The experts were asked to rate each statement on a scale of 1-9, where 1 meant "completely disagree" and 9 meant "completely agree".
  
  
  RESULTS
  Thirty-three oncologists responded to both rounds of the survey (62.3 % of total surveyed). On issues related to pathology and diagnosis, patterns of response, and immuno-oncology, the specialists reached a high level of consensus. There was also a high level of agreement, albeit without consensus on assessment of BRAF mutations before deciding on treatment with ipilimumab. However, there was a lower level of agreement on sequencing treatment with BRAF inhibitors and ipilimumab, on predictive factors, on the use of corticosteroids, and on patient quality of life.
  
  
  CONCLUSIONS
  The disparity in many of these topics suggests that oncologists need more information on certain aspects of ipilimumab treatment. We need to define generally accepted algorithms of treatment, especially with regard to issues that were shown to be controversial or unclear.
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra. Instituto de Investigación Sanitaria de Navarra (IDISNA), Av. Pío XII, 36, 31008, Pamplona, Navarra, España, Spain. smalgarra@unav.es.
authors.forename: S
authors.initials: S
authors.lastname: Martín-Algarra
authors.affiliation: Department of Clinical Oncology, Hospital Virgen Macarena, Seville, Spain.
authors.forename: L
authors.initials: L
authors.lastname: de la Cruz-Merino
authors.affiliation: Department of Oncology, Instituto Valenciano Oncología, Valencia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Soriano
authors.affiliation: Department of Oncology, Hospital Germans Trias i Pujol. ICO-Badalona, Barcelona, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Manzano
authors.affiliation: Department of Oncology, Hospital La Paz, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Espinosa
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D006801:Humans; D000074324:Ipilimumab; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011788:Quality of Life; D013030:Spain; D011795:Surveys and Questionnaires
chemical_list: D000911:Antibodies, Monoclonal; D000074324:Ipilimumab
keywords: Consensus; Immunotherapy; Ipilimumab; Melanoma; Oncology; Spain