Aim: First-line (1L) immunotherapy has yielded superior overall survival (OS) in metastatic melanoma (MM) but some patients are ineligible for immunotherapy or need rapid response with 1L targeted therapy (TT).Materials & methods: Retrospective cohort study of real-world patients treated with 1L immunotherapy (144 BRAF wild type, 85 BRAF-mutated) or 1L TT (143 BRAF-mutated) for MM in Finland during 2014-2021.Results: Baseline brain metastases, liver metastases and elevated LDH were less common, 2-year OS rates were higher (60.3-63.5% vs. 33.8%) and more patients were alive without the next-line treatment (38.0-43.8% vs. 23.3%) in patients with 1L immunotherapy.Conclusion: Real-world patients with 1L immunotherapy for MM had favorable baseline characteristics and better treatment outcomes than observed in patients with 1L TT.
Keywords: BRAF; brain metastasis; immunotherapy; lactate dehydrogenase; liver metastasis; melanoma; overall survival; real-world evidence; targeted therapy.
Real-world results of immunotherapy or targeted therapy as the first treatment option for metastatic melanoma in Finland: During the last ten years, immunotherapy and targeted therapy have improved the survival of patients with metastatic melanoma. We have studied 372 patients who had received immunotherapy or targeted therapy as the first treatment option for metastatic melanoma in Finland during 2014–2021. We found that the patients treated with immunotherapy had smaller disease burden and less commonly liver and brain metastases than the patients treated with targeted therapy. This could partly explain longer time to next treatment and longer survival achieved with immunotherapy. Over 40% of all patients received next treatment after the first treatment failed to keep their disease under control. These patients need urgently new treatment options.