The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma: results from a European expert panel study

Paolo A Ascierto, Lars Bastholt, Pier F Ferrucci, Johan Hansson, Iván Márquez Rodas, Miranda Payne, Caroline Robert, Luc Thomas, Jochen S Utikal, Pascal Wolter, Amber Kudlac, Harriet Tuson, Jan McKendrick

Research output: Contribution to journalArticle

Abstract

Treatment decisions for advanced melanoma are increasingly complex and guidelines provide limited advice on how to choose between immunotherapy and targeted therapy for first-line treatment. A Delphi study was carried out to understand which patient characteristics and disease-related factors inform clinicians' choices of first-line treatment for BRAF-mutated melanoma. Twelve European melanoma specialists experienced in using immunotherapies and targeted agents participated in a double-blind two-phase Delphi study. In phase 1, participants completed a questionnaire developed after reviewing patient characteristics and disease-related factors reported in trials, clinical guidelines, and health technology assessments. Phase 2 was an expert panel meeting to explore outstanding issues from phase 1 and seek consensus, defined as 80% agreement. Twenty patient-related and disease-related characteristics were considered. There was consensus that tumor burden (83% of clinicians) and disease tempo (83%) are very or extremely important factors when selecting first-line treatment. Several components were deemed important when assessing tumor burden: brain metastases (82% of clinicians) and location of metastases (89%). There was consensus that disease tempo can be quantified in clinical practice, but not on a formal classification applicable to all patients. Lactate dehydrogenase level is a component of both tumor burden and disease tempo; all clinicians considered lactate dehydrogenase important when choosing first-line treatment. The majority (92%) did not routinely test programmed death ligand-1 status in patients with melanoma. Clinicians agreed that choosing a first-line treatment for advanced melanoma is a complex, multifactorial process and that clinical judgment remains the most important element of decision-making until research can provide clinicians with better scientific parameters and tools for first-line decision-making.

Original languageEnglish
Pages (from-to)333-340
Number of pages8
JournalMelanoma Research
Volume28
Issue number4
DOIs
Publication statusPublished - Aug 2018

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Melanoma
Tumor Burden
Delphi Technique
Consensus
L-Lactate Dehydrogenase
Immunotherapy
Therapeutics
Decision Making
Guidelines
Neoplasm Metastasis
Biomedical Technology Assessment
Clinical Trials
Ligands
Brain
Research

Keywords

  • Double-Blind Method
  • Europe
  • Female
  • Humans
  • Male
  • Melanoma/drug therapy
  • Proto-Oncogene Proteins B-raf
  • Skin Neoplasms/drug therapy
  • Surveys and Questionnaires

Cite this

The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma : results from a European expert panel study. / Ascierto, Paolo A; Bastholt, Lars; Ferrucci, Pier F; Hansson, Johan; Márquez Rodas, Iván; Payne, Miranda; Robert, Caroline; Thomas, Luc; Utikal, Jochen S; Wolter, Pascal; Kudlac, Amber; Tuson, Harriet; McKendrick, Jan.

In: Melanoma Research, Vol. 28, No. 4, 08.2018, p. 333-340.

Research output: Contribution to journalArticle

Ascierto, PA, Bastholt, L, Ferrucci, PF, Hansson, J, Márquez Rodas, I, Payne, M, Robert, C, Thomas, L, Utikal, JS, Wolter, P, Kudlac, A, Tuson, H & McKendrick, J 2018, 'The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma: results from a European expert panel study', Melanoma Research, vol. 28, no. 4, pp. 333-340. https://doi.org/10.1097/CMR.0000000000000455
Ascierto, Paolo A ; Bastholt, Lars ; Ferrucci, Pier F ; Hansson, Johan ; Márquez Rodas, Iván ; Payne, Miranda ; Robert, Caroline ; Thomas, Luc ; Utikal, Jochen S ; Wolter, Pascal ; Kudlac, Amber ; Tuson, Harriet ; McKendrick, Jan. / The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma : results from a European expert panel study. In: Melanoma Research. 2018 ; Vol. 28, No. 4. pp. 333-340.
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