Real-world outcomes among US Merkel cell carcinoma patients initiating immune checkpoint inhibitors or chemotherapy

Future Oncol. 2020 Nov;16(31):2521-2536. doi: 10.2217/fon-2020-0453. Epub 2020 Sep 4.

Abstract

Aim: Retrospectively assessed treatment patterns and clinical and economic outcomes in Merkel cell carcinoma (MCC) patients receiving recommended first-line regimens. Materials & methods: MCC patients newly treated with either immune checkpoint inhibitors (ICIs) or chemotherapies (CTs) were selected from the Veterans Health Administration database (2013-2018); 74 patients (ICIs: 20 and CTs: 54) were selected. Results: Median duration of therapy was 300 days for ICIs and 91 days for CTs. Time to next treatment was 245 and 184 days, respectively. Mean total (per patient per month) costs were $15,306 (ICIs) and $10,957 (CTs), of which 51% and 86%, respectively, were non-MCC therapy-related costs. Conclusion: Despite higher costs, utilization of ICIs in first-line MCC shows clinical advantages over CTs in the real world.

Keywords: Merkel cell carcinoma; Veterans Health Administration; duration of treatment; health care resource utilization; immune checkpoint inhibitors; recommended chemotherapy; survival; time to next treatment.

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Merkel Cell / diagnosis
  • Carcinoma, Merkel Cell / drug therapy*
  • Carcinoma, Merkel Cell / epidemiology*
  • Carcinoma, Merkel Cell / etiology
  • Combined Modality Therapy
  • Comorbidity
  • Duration of Therapy
  • Female
  • Health Care Costs
  • Humans
  • Immune Checkpoint Inhibitors / administration & dosage
  • Immune Checkpoint Inhibitors / adverse effects
  • Immune Checkpoint Inhibitors / therapeutic use*
  • Kaplan-Meier Estimate
  • Male
  • Prognosis
  • Retrospective Studies
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / epidemiology*
  • Skin Neoplasms / etiology
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Antineoplastic Agents
  • Immune Checkpoint Inhibitors