Real World Outcomes in Patients with Advanced Melanoma Treated in Alberta, Canada: A Time-Era Based Analysis.

Immune checkpoint and MAP kinase pathway inhibitors can significantly improve long-term survival for patients with melanoma. There is limited real-world data of these regimens' effectiveness. We retrospectively analyzed 402 patients with unresectable and metastatic melanoma between August 2013 and July 2020 treated with immune checkpoint inhibitors and MAP kinase pathway targeted therapy in Alberta, Canada. Overall survival (OS) was compared using Kaplan-Meier and Cox regression analyses. Subgroup survival outcomes were analyzed by first-line treatment regime and BRAF mutation status. Three treatment eras were defined based on drug access: prior to August 2013, August 2013 to November 2016, and November 2016 to July 2020. Across each era, there were improvements in median OS: 11.7 months, 15.9 months, and 33.6 months, respectively. Patients with BRAF mutant melanoma had improved median OS when they were treated with immunotherapy in the first line as opposed to targeted therapy (median OS not reached for immunotherapy versus 17.4 months with targeted treatment). Patients with BRAF wild-type melanomas had improved survival with ipilimumab and nivolumab versus those treated with a single-agent PD-1 inhibitor (median OS not reached and 21.2 months). Our real-world analysis confirms significant survival improvements with each subsequent introduction of novel therapies for advanced melanoma.

The effect of age on referral to an oncologist and receipt of chemotherapy among small cell lung cancer patients in Ontario, Canada.

OBJECTIVES: Small cell lung cancer (SCLC) represents a significant health burden. There is a lack of information about patterns of referral and treatment for older patients over 70 years of age, in comparison to younger patients with SCLC. MATERIALS AND METHODS: A population-based retrospective cohort study was undertaken for patients identified from the Ontario Cancer Registry, Canada. All cases of SCLC diagnosed between January 2000 and December 2010 were eligible. Data were extracted on demographic variables, treatment and outcome. Logistic regression analyses were performed as appropriate. RESULTS: There were 9021 cases of SCLC, with 10% of cases ≥80 years and 32.8% of cases aged 70-79 years and 53% male. Older patients were less likely to be referred to a medical oncologist (OR 0.28 ≥ 80 years, OR 0.60 70-79 years) and less likely to receive chemotherapy (OR 0.19 ≥ 80 years, OR 0.52 70-79 years) compared to younger patients (age < 70). Age, higher comorbidity and prior receipt of home care services were all prognostic of a lower likelihood of referral to a medical oncologist and receipt of chemotherapy. Local health region was also prognostic for referral to and receipt of chemotherapy, indicative of significant regional variation in practice. CONCLUSIONS: Older patients with SCLC are less likely to be referred for treatment and less likely to receive treatment than younger patients. These data represent a potential gap in knowledge translation.