Researchers identified sociodemographic factors associated with increased likelihood to receive immunotherapy for metastatic melanoma in the US (JAMA Netw Open. 2020;1;3[9]:e2015656. doi:10.1001/jamanetworkopen.2020.15656).
“Strides to improve survival in metastatic melanoma have been made with the use of immunotherapeutic agents in the form of immune checkpoint inhibitors,” wrote Justin T Moyers, MD, Division of Hematology and Oncology, Department of Internal Medicine, Loma Linda University, California, and colleagues.
In order to examine sociodemographic factors associated with immunotherapy receipt among patients with metastatic melanoma, Dr Moyers and colleagues conducted a cohort study.
The study used data from the National Cancer Database on 9882 patients with metastatic melanoma diagnosed from January 1, 2013 and December 31, 2016. Data analysis was performed from July 1, 2019, to December 15, 2019.
The primary end point was the association of receipt of immunotherapy as first-line therapy with sociodemographic factors. The secondary end point was overall survival (OS) by receipt of immunotherapy.
A total of 9512 patients met the inclusion criteria for the analysis. Of these patients, 3428 (36%) received immunotherapy and 6084 (64%) did not.
On regression analysis, factors associated with a decreased likelihood of receiving immunotherapy included Increasing age (odds ratio [OR], 0.98; 95% CI, 0.97-0.98; P <.001) and increasing Charlson-Deyo comorbidity index (OR, 0.86; 95% CI, 0.80-0.92; P <.001).
Factors associated with an increased likelihood of receiving immunotherapy included melanoma diagnosis in Medicaid expansion states (OR, 1.16; 95% CI, 1.05-1.27; P = .003), treatment at an academic or integrated cancer network program (OR, 1.59; 95% CI, 1.45-1.75; P <.001), and residence within the highest quartile of high school graduation rate zip codes (OR, 1.31; 95% CI, 1.09-1.56; P = .003).
Among all patients, the median OS was 10.1 months (95% CI, 9.6-10.6 months). Patients who received first-line immunotherapy had a median overall survival of 18.4 months (95% CI, 16.6-20.1 months) compared with 7.5 months (95% CI, 7.0-7.9 months) (P <.001) among patients who did not.
“Recognizing sociodemographic associations with treatment receipt is important to identify potential barriers to treatment,” concluded Dr Moyers and colleagues.—Janelle Bradley
