Use of new systemic therapies has contributed to a significant decrease in cutaneous melanoma deaths in the U.S., according to a study published online in American Journal of Public Health (Mar. 19, 2020). The study looked at melanoma incidence and mortality among Whites—identifying them as the group most affected by melanoma—in nine U.S. Surveillance, Epidemiology, and End Results registry areas that recorded data between 1986 and 2016. Investigators found that there had been an overall 7.5% increase in melanoma mortality in the U.S. between 1986 to 2013. However, after the U.S. Food and Drug Administration approved 10 new treatments for metastatic melanoma beginning in 2011, overall mortality decreased by 17.9% from 2013 to 2016 (annual per cent change [APC] = −6.2%; 95% confidence interval [CI] = −8.7%, −3.7%). In particular, sharp declines were seen among men aged 50 years or older (APC = −8.3%; 95% CI = −12.2%, −4.1%) starting in 2014. These new treatments are mostly those that target the BRAF gene and immune checkpoint inhibitors, according to the paper. The authors note that this recent, multiyear decline is the largest and most sustained improvement in melanoma mortality ever observed and is unprecedented in cancer medicine, outstripping comparable decreases in cancers of the prostate, breast and lung. “Our findings show how quickly patients and physicians accepted these new drugs because they profoundly reduce deaths from melanoma,” said co-senior study author Dr. David Polsky, in a press release. “These therapies are now considered the backbone of how we treat this cancer,” said Dr. Polsky, the Alfred W. Kopf, MD, professor of dermatologic oncology at NYU Langone Health and Perlmutter Cancer Center in New York. The steep drop in deaths is unlikely to be due to better detection, Dr. Polsky said, as the death rates dropped sharply, rather than steadily over time. Additionally, the push for early detection exams has been ongoing since the 1980s, so the timing of these declines matches up better with the introduction of the new therapies. This paper’s authors do caution that early detection is still important, since it allows for the use of less toxic forms of treatment and lowered healthcare costs. They emphasized that prevention, avoiding excessive UV light exposure, and promptly seeking medical care when there is a change in the skin’s appearance, are crucial to reducing the risk of developing metastatic melanoma. Dr. Polsky said that future studies should investigate socioeconomic factors that may affect access to the newer therapies, as they are more expensive than older options. He also said the effect of these treatments on other ethnic groups should be studied.
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