The objective of this study was to describe real-world adjuvant therapy (AT) use by disease substage and assess determinants of treatment choice among patients with stage III melanoma. This non-interventional retrospective study included survey responses and data from patient records provided by US medical oncologists. Survey responses, patient demographic/clinical characteristics, treatment utilization, and reasons for treatment were reported descriptively. The association between patient and disease characteristics and AT selection was assessed using logistic and multinomial regression models, overall and stratified by AJCC8 substage (IIIA vs. IIIB/C/D) and type of AT received (anti-PD1 monotherapy, BRAF/MEK, no AT), respectively. In total 152 medical oncologists completed the survey and reviewed the charts of 507 patients (168 stage IIIA; 339 stages IIIB/IIIC/IIID); 405 (79.9%) patients received AT (360/405 (88.9%) received anti-PD1 therapy; 45/405 (11.1%) received BRAF/MEK therapy). Physicians reported clinical guidelines (61.2%), treatment efficacy (37.5%), and ECOG performance status (31.6%) as drivers of AT prescription. Patient-level data confirmed that improving patient outcomes (79%) was the main reason for anti-PD1 prescription; expected limited treatment benefit (37%), patient refusal (36%), and toxicity concerns (30%) were reasons for not prescribing AT. In multivariable analyses stage IIIB/IIIC/IIID disease significantly increased the probability of receiving AT (odds ratio [OR] 1.74) and anti-PD1 therapy (OR 1.82); ECOG 2/3 and Medicaid/no insurance decreased the probability of AT receipt (OR 0.37 and 0.42, respectively) and anti-PD1 therapy (OR 0.41 and 0.42, respectively) among all patients and patients with stage IIIA disease. Most patients were given AT with a vast majority treated with an anti-PD1 therapy. Physician- and patient-level evidence confirmed the impact of disease substage on AT use, with stage IIIA patients, patients without adequate insurance coverage, and worse ECOG status having a lower probability of receiving AT.

中文翻译：

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评估美国 III 期皮肤黑色素瘤抗 PD1 单一疗法作为辅助疗法的使用情况以及治疗选择的决定因素

本研究的目的是描述现实世界中不同疾病亚期的辅助治疗 (AT) 使用情况，并评估 III 期黑色素瘤患者治疗选择的决定因素。这项非干预性回顾性研究包括美国肿瘤内科医师提供的调查回复和患者记录数据。描述性地报告了调查答复、患者人口统计/临床特征、治疗利用和治疗原因。使用逻辑回归和多项回归模型评估患者和疾病特征与 AT 选择之间的关联，并按 AJCC8 亚期（IIIA 与 IIIB/C/D）和接受的 AT 类型（抗 PD1 单一疗法、BRAF/MEK、无 AT）。共有 152 名肿瘤内科医师完成了调查并审查了 507 名患者的图表（168 名 IIIA 期；339 名 IIIB/IIIC/IIID 期）； 405 名（79.9%）患者接受 AT（360/405（88.9%）接受抗 PD1 治疗；45/405（11.1%）接受 BRAF/MEK 治疗）。医生报告临床指南 (61.2%)、治疗效果 (37.5%) 和 ECOG 表现状态 (31.6%) 作为 AT 处方的驱动因素。患者层面的数据证实，改善患者预后（79%）是抗PD1处方的主要原因；预期治疗效果有限 (37%)、患者拒绝 (36%) 和毒性担忧 (30%) 是不开 AT 处方的原因。在多变量分析中，IIIB/IIIC/IIID 期疾病显着增加接受 AT（比值比 [OR] 1.74）和抗 PD1 治疗（OR 1.82）的可能性； ECOG 2/3 和医疗补助/无保险降低了所有患者和 IIIA 期疾病患者接受 AT（分别为 OR 0.37 和 0.42）和抗 PD1 治疗（分别为 OR 0.41 和 0.42）的概率。大多数患者接受了 AT 治疗，其中绝大多数接受了抗 PD1 疗法。医生和患者层面的证据证实了疾病亚期对 AT 使用的影响，IIIA 期患者、没有足够保险范围的患者以及 ECOG 状态较差的患者接受 AT 的可能性较低。