Melanoma care is revolutionized with checkpoint inhibitors (CPI) and targeted therapies; however, access to drugs is challenging in Low-Middle income countries (LMICs).
Histologically proven melanoma cases registered from 2013–2019 were analysed.
There were 443 patients with median age of 54 years; 60% were males with 41% cutaneous, and 57% mucosal melanomas; most common primary sites were anorectal (41%) and extremities (27%); 11% were BRAF mutated. Among the 258 non-metastatic patients, the median follow up was 30 months (0–83 months). Of these, 114 (44%) had prior surgery and 73 (64%) were already metastatic at presentation to us. Of the remaining 144 (56%), 101 underwent resection, 11 were unresectable, and rest 32 did not take treatment. Median EFS of non-metastatic patients was 17 (95% CI: 11-23) months while median OS was 38 months (95% CI: 30-46); 2-years OS predictions was 66% (95% CI: 59-73). Overall metastatic cohort (n=311) comprised of baseline metastatic (n=185) and non-metastatic patients with (73) or without prior therapy (53) who failed with distant metastasis.Commonest metastatic sites were liver (52%) and non-regional nodes (51%). Median follow up in this cohort was 21 (0–74 months); 138 (44.4%) received chemotherapy(taxane, dacarbazine), Interferons, while 29 (9.3%) patients received CPI. The clinical benefit rate was 31%. In baseline metastatic cohort, the median EFS and OS with BSC alone were 3.8 (95% CI: 2.6-5.0) months and 3.5 (95% CI: 2.45-4.63) vs. 5.55 (95% CI: 3-8) months and 11 (95% CI: 9-13.1) months in any systemic therapy group (HR for OS: 0.34, 95% CI: 0.22-0.52; P<0.001). Grade 3/4 toxicity were observed in 16 % with predominance of thrombocytopenia and anemia (both 4%) in chemotherapy and anemia (10%) for CPI. Any therapy received was significant in both cohort;additionally, site, surgery, were significant in non-metastatic cohort.
This real-world data from India reflects the hard reality of access of expensive, standard of care therapies. Interesting finding that any systemic therapy can lead to meaningful clinical benefits at-least in a select group of patients merits exploration if standard options are not feasible, especially in LMICs.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.