New Systematic Therapies and Trends in Cutaneous Melanoma Deaths Among US Whites, 1986–2016

Juliana Berk-Krauss, MD; Jennifer A. Stein, MD, PhD; Jeffrey Weber, MD, PhD; David Polsky, MD, PhD; Alan C. Geller, RN, MPH

Disclosures

Am J Public Health. 2020;110(5):731-733. 

In This Article

Abstract and Introduction

Abstract

Objectives: To determine the effect of new therapies and trends toward reduced mortality rates of melanoma.

Methods: We reviewed melanoma incidence and mortality among Whites (the group most affected by melanoma) in 9 US Surveillance, Epidemiology, and End Results registry areas that recorded data between 1986 and 2016.

Results: From 1986 to 2013, overall mortality rates increased by 7.5%. Beginning in 2011, the US Food and Drug Administration approved 10 new treatments for metastatic melanoma. From 2013 to 2016, overall mortality decreased by 17.9% (annual percent change [APC] = −6.2%; 95% confidence interval [CI] = −8.7%, −3.7%) with sharp declines among men aged 50 years or older (APC = −8.3%; 95% CI = −12.2%, −4.1%) starting in 2014. This recent, multiyear decline is the largest and most sustained improvement in melanoma mortality ever observed and is unprecedented in cancer medicine.

Conclusions: The introduction of new therapies for metastatic melanoma was associated with a significant reduction in population-level mortality. Future research should focus on developing even more effective treatments, identifying biomarkers to select patients most likely to benefit, and renewing emphasis on public health approaches to reduce the number of patients with advanced disease.

Introduction

Mortality rates for many cancers have declined gradually since the early 1990s, but the overall melanoma mortality rate had been rising. Increases in melanoma mortality were highest among older individuals, particularly men.[1] Since 2011, the US Food and Drug Administration (FDA) approved 10 new therapies for the treatment of metastatic melanoma, including first- and second-generation immune checkpoint blocking antibodies (anti-CTLA-4 [T-lymphocyte-associated protein 4] and anti-PD-1 [programmed death protein 1], respectively) and B-RAF proto-oncogene (BRAF) and mitogen-activated protein kinase kinase (MEK) inhibitors, as well as talimogene laherparepvec.[2] We investigated whether these drugs may have had an effect on population-level mortality data because 6 of these 10 agents were approved between 2011 and 2014.

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