P193 A decade of change: trends in systemic anticancer therapy and radiotherapy for melanoma in England

Abstract

Since 2010, new therapeutic immunotherapies and targeted therapies have been available for the management of advanced cutaneous melanoma. This study reports trends in English people with melanoma receiving systemic anticancer therapy (SACT) and radio­therapy (RT). Using openly available National Disease Registration Service (NDRS) datasets, data were extracted on the percentage of melanomas treated with SACT or RT between 2013 and 2022. SEER Joinpoint regression analysis (version 5.4.0) was used to assess trends and report the annual percentage change (APC) of the proportions of cases with SACT and RT used. Incidence rate ratios (IRRs) are reported. UICC TNM version 7 was used for staging until 2017, and version 8 from 2018 onwards. Between 2013 and 22, there were 145 544 registered cases of melanoma. The proportion of SACT use increased from 3.6% to 13.1%. Overall, the APC was 16.8%. A trend change was identified in 2020 coinciding with the COVID-19 pandemic: the APC was 22.7% for 2013–20, P < 0.001, then −1.1% for 2020–22, P = 0.88. There was a 15% reduction in SACT use in 2020 vs. 2019 (IRR 0.85; P < 0.001). The percentage of SACT use increased significantly across all stages, with the greatest increase for stage III (APC 17.0%; P < 0.001). RT use from 2013 to 2022 reduced from 3.7% to 2.4% (P < 0.001), with a pandemic-associated increase in 2020 vs. 2019 (IRR 1.22; P = 0.007). APCs for the percentage use of RT fell for every disease stage; however, not all of these changes were statistically significant. The increased use of immunotherapy and targeted treatments combined with adjuvant approval for earlier stages likely contributes to improved melanoma mortality in England. This corresponds to the greater increases in usage after NICE approval for stage 3 disease in 2018. Given the expensive nature of SACT, emphasis needs to be on prevention and early diagnosis.