title: Metastatic Melanoma: Treatment and Survival in the US after the Introduction of Ipilimumab and Vemurafenib.
abstract: BACKGROUND
  The 5-year survival of metastatic melanoma is < 18%. Historically, treatment options were limited. In 2011, 2 new agents were approved.
  
  
  METHODS
  We re-abstracted the medical records of a random sample (n = 520) of metastatic melanoma patients who had been diagnosed in 2011 and reported to population-based registries in the U.S. We also queried their treating physicians. Factors associated with treatment and survival were assessed using logistic and Cox proportional hazards regressions, respectively.
  
  
  RESULTS
  21.4% of patients received no treatment, 20.8% received ipilimumab and 57.5% of patients with BRAF-positive tumors received vemurafenib/dabrafenib. Receipt of ipilimumab was less likely among patients of 75 years or older (vs. < 55 years: odds ratio (OR) 0.32; 95% confidence interval (CI) 0.15-0.66) and patients without private/military insurance. 46.8% of patients received BRAF testing. Receipt of BRAF testing was less likely among patients of 65 years or more and uninsured patients (OR 0.22; 95% CI 0.07-0.65). Receipt of ipilimumab was associated with better survival during the first 18 months after diagnosis (hazard ratio (HR) 0.66; 95% CI 0.51-0.84) and vemurafenib/dabrafenib with better survival during the first 10 months after diagnosis (HR 0.51; 95% CI 0.36-0.73).
  
  
  CONCLUSIONS
  The initial dissemination of ipilimumab and vemurafenib/dabrafenib was limited. Additional research is needed to investigate the apparent lack of long-term survival benefit from these agents.
authors.affiliation: Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Enewold
authors.forename: Elad
authors.initials: E
authors.lastname: Sharon
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D007211:Indoles / Q000008:administration & dosage*; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D008875:Middle Aged; D010091:Oximes / Q000008:administration & dosage*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D013449:Sulfonamides / Q000008:administration & dosage*; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D000077484:Vemurafenib
chemical_list: D000911:Antibodies, Monoclonal; D007093:Imidazoles; D007211:Indoles; D000074324:Ipilimumab; D010091:Oximes; D013449:Sulfonamides; D000077484:Vemurafenib; C561627:dabrafenib