Population Mortality in Advanced Melanoma Patients with and Without Response and Progression; Data from the Dutch Melanoma Treatment Registry

Introduction: When analysing patient survival, one is often interested in cause of death. Little is known about the presence of population mortality in advanced melanoma patients. The aim of this study was to assess population mortality after different response states in advanced melanoma patients in the Netherlands and analyze the contribution of disease and population mortality for different age groups.

Methods: We selected patients diagnosed between 2013-2019 with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry. A multi-state model with response states integrating population mortality was fitted. One-year landmark analyses were performed to assess outcomes after each response state.

Results: Overall, 5119 patients were selected. Five-year probabilities of melanoma-related mortality in patients alive in CR at one year after diagnosis increased with age and was 17.2% (95%CI: 13.0-21.4) for patients aged <65 years and 28.7% (95%CI: 24.3-33.1) in patients aged ≥80 years. Population mortality only played a large role for older patients (75 years and above) alive at 1 year after diagnosis with a PR or CR.

Conclusion: Even though survival outcomes of advanced melanoma patients have improved over the last decade, the vast majority of patients still die due to melanoma-related mortality.

Funding Information: For the Dutch Melanoma Treatment Registry (DMTR), the Dutch Institute for Clinical Auditing foundation received a start-up grant from governmental organization The Netherlands Organization for Health Research and Development (ZonMW, project number 836002002). The DMTR is structurally funded by Bristol Myers Squibb, Merck Sharpe & Dohme, Novartis and Roche Pharma. Roche Pharma stopped funding in 2019 and Pierre Fabre started funding of the DMTR in 2019. For this work no funding was granted.

Declaration of Interests: AvdE has advisory relationships with Amgen, Bristol Myers Squibb, Roche, Novartis, MSD, Pierre Fabre, Sanofi, Pfizer, Ipsen, Merck and has received research study grants not related to this paper from Sanofi, Roche, Bristol Myers Squibb, Idera and TEVA and has received travel expenses from MSD Oncology, Roche, Pfizer and Sanofi and has received speaker honoraria from BMS and Novartis. MBS has consultancy/advisory relationships with Pierre Fabre, MSD and Novartis. JdG has consultancy/advisory relationships with Bristol Myers Squibb, Pierre Fabre, Servier, MSD, Novartis. GH consultancy/advisory relationships with Amgen, Bristol Myers Squibb, Roche, MSD, Pfizer, Novartis, Pierre Fabre and has received research grants not related to this paper from Bristol Myers Squibb, Seerave and were paid to the institution. EK has consultancy/advisory relationships with Bristol Myers Squibb, Novartis, Merck, Pierre Fabre, and received research grants not related to this paper from Bristol Myers Squibb. KS has advisory relationships with Bristol Myers Squibb, Novartis, MSD, Pierre Fabre, Abbvie and received honoraria from Novartis, MSD and Roche. AvdV has consultancy relationships with Bristol Myers Squibb, MSD, Roche, Novartis, Pierre Fabre, Pfizer, Sanofi, Ipsen, Eisai, Merck. CUB has received commercial research grants from Novartis, BristolMyers Squibb, and NanoString; is a paid advisory board member for Bristol Myers Squibb, MSD, Roche, Novartis, GlaxoSmithKline, AstraZeneca, Pfizer, Lilly, GenMab, and Pierre Fabre; and holds ownership interest in Uniti Cars, Neon Therapeutics, and Forty Seven. JH has advisory relationships with, Achilles Therapeutics, Bristol Myers Squibb BioNTech, Immunocore, Ipsen, Instil Bio, Iovance Bio, MSD, Merck Serono, Molecular Partners, Novartis, Neogene Therapeutics, , Pfizer, Roche/Genentech, Sanofi, T-Knife and has received research grants not related to this paper from Asher Bio, Amgen, Bristol Myers Squibb, MSD, BioNTech, Neogene Therapeutics and Novartis. MA has advisory board / consultancy honoraria from Amgen, Bristol Myers Squibb, Novartis, MSD Merck, Merck-Pfizer, Pierre Fabre, Sanofi, Astellas, Bayer. Research grants Merck-Pfizer. Not related to current work and paid to institute. RS has advisory board / consultancy honoraria from Pfizer and an expert meeting fee from Roche. All grants were paid to the institutions. The funders had no role in the writing of this article or decision to submit it for publication. All remaining authors have declared no conflicts of interest.

Keywords: relative survival, advanced melanoma, population mortality, older patients, response status, multi-state model

Suggested Citation: Suggested Citation

van Breeschoten, Jesper and van den Eertwegh, Alfons J.M. and Hilarius, Doranne L. and Haanen, John and Blank, Christian U. and Aarts, Maureen J.B. and van den Berkmortel, Franchette W.P.J. and de Groot, Jan Willem B. and Hospers, Geke A.P. and Kapiteijn, Ellen and Piersma, Djura P. and van Rijn, Rozemarijn S. and Stevense-den Boer, Marion A. and Vreugdenhil, Gerard and Boers-Sonderen, Marye J. and Manevski, Damjan and Suijkerbuijk, Karijn P.M. and Wouters, Michel W.J.M. and de Wreede, Liesbeth C., Population Mortality in Advanced Melanoma Patients with and Without Response and Progression; Data from the Dutch Melanoma Treatment Registry. Available at SSRN: https://ssrn.com/abstract=4267708 or http://dx.doi.org/10.2139/ssrn.4267708