Objective. To describe treatment patterns and factors influencing treatment in a real-world setting of US patients with metastatic melanoma (MM). Methods. This was a retrospective claims-based study among patients with MM diagnosed between 2005 and 2010 identified from MarketScan databases. Results. Of 2546 MM patients, 66.8% received surgery, 44.7% received radiation, 38.7% received systemic therapies, and 17.7% received all modalities. Patients with lung, brain, liver, or bone metastases were less likely to undergo surgery (all ); patients with lung ( ), brain ( ), or liver metastases ( ) were more likely to receive systemic therapies; patients with brain ( ) or bone metastases ( ) were more likely to receive radiation therapy. Oncologists were more likely to recommend systemic therapy ( ) or radiation ( ), while dermatologists were more likely to recommend surgery ( ). Monotherapy was the dominant systemic therapy (82.4% patients as first-line). Conclusions. Only 39% of MM patients received systemic therapies, perhaps reflecting efficacy and safety limitations of conventional systemic therapies for MM. Among those receiving systemic therapy, monotherapy was the most common approach. Sites of metastases and physician speciality influenced treatment patterns. This study serves as a baseline against which future treatment pattern studies, following approval of new agents, can be compared. 1. Introduction Melanoma has the fastest rising incidence rate compared with that of any other malignancy [1]. Metastatic melanoma (MM) is the most aggressive form of skin cancer and generally has a poor prognosis with a median overall survival of 6–10 months and a 5-year survival of 5–10%, depending on the location of the metastasis [2], compared with 5-year survival rates of 98.2% and 62.4% for localised and regional melanoma, respectively [3]. Prior to the approval of ipilimumab and vemurafenib in 2011, only two therapies were approved by the US Food and Drug Administration for treatment of MM, dacarbazine and high-dose interleukin-2 (HD IL-2). Since its approval in the 1970s, dacarbazine monotherapy has been commonly used for the treatment of MM [4], although its use is limited by a low response rate [5, 6] as well as a lack of an overall survival benefit and significant toxicity [7]. HD IL-2 is associated with durable responses in only a small percentage of carefully selected patients [8] and is limited by severe toxicities [9]. Prior to the introduction of the newer agents, treatment guidelines recommended resection, observation, or systemic therapy for patients
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