Audibert Céline, Stuntz Mark, Glass Daniel
Deerfield Institute, Epalinges, Switzerland.
Deerfield Institute, New York, NY, USA.
J Pharm Technol. 2018 Feb;34(1):17-23. doi: 10.1177/8755122517747089. Epub 2017 Dec 4.
Treatment of advanced -mutant melanoma has changed dramatically in the past 3 years thanks to the approval of new immunotherapy and targeted therapy agents. The goal of our survey was to investigate when immunotherapy and targeted therapy are used in the management of advanced melanoma patients and whether differences exist between the types of setting. Oncologists from academic centers, community-based centers, and private clinics were invited to participate in an online survey. Survey questions addressed the proportion of BRAF-mutant patients per treatment line, proportion of patients on targeted therapy and immunotherapy available in the United States, and reasons for prescribing each drug class. A total of 101 physicians completed the survey, of which 47 worked in a private clinic, 33 in an academic center, and 21 in a community-based center. Academic center participants tended to see more severe patients ( < .001) and had more patients in second-line treatment than participants from other setting types. In addition, academic center physicians had more patients in clinical trials ( < .001), and they prescribed the ipilimumab and nivolumab combination more frequently. In terms of sequencing, all participants used targeted therapy for severe or rapidly progressing patients and immunotherapy for those who were less severe or slowly progressing. The findings illustrate the differences in treatment approach per type of setting, with patients in academic centers more likely to receive recently approved products or to be enrolled in clinical trials than those in community-based settings.
在过去3年中，由于新型免疫疗法和靶向治疗药物的获批，晚期突变型黑色素瘤的治疗发生了巨大变化。我们此次调查的目的是研究免疫疗法和靶向治疗在晚期黑色素瘤患者管理中的使用时机，以及不同治疗场景之间是否存在差异。来自学术中心、社区中心和私人诊所的肿瘤学家受邀参与一项在线调查。调查问题涉及各治疗线中BRAF突变患者的比例、美国可用的靶向治疗和免疫治疗患者的比例，以及开具各类药物的原因。共有101名医生完成了调查，其中47名在私人诊所工作，33名在学术中心工作，21名在社区中心工作。学术中心的参与者往往诊治病情更严重的患者（P<0.001），且二线治疗的患者比其他治疗场景类型的参与者更多。此外，学术中心的医生有更多患者参与临床试验（P<0.001），并且他们更频繁地开具伊匹单抗和纳武单抗联合用药。在治疗顺序方面，所有参与者对病情严重或进展迅速的患者使用靶向治疗，对病情较轻或进展缓慢的患者使用免疫治疗。研究结果表明了不同治疗场景下治疗方法的差异，学术中心的患者比社区环境中的患者更有可能接受最近获批的产品或参与临床试验。
