More flexibility needed in melanoma treatment

Feb 16 2015

Dr Craig Gedye

Survival rates would be improved by making treatment regimens for metastatic melanoma more flexible, according to HMRI cancer researcher Dr Craig Gedye, a medical oncologist at the Calvary Mater Newcastle.

In a letter published today in the Medical Journal of Australia – co-authored by Professor Frances Boyle, director of the Patricia Ritchie Centre at the Mater Hospital in Sydney – Dr Gedye claims that the existing Australian treatment sequence is “potentially inferior”.

As mandated by the Pharmaceutical Benefits Scheme, Australian patients with ‘BRAF-mutated’ metastatic melanoma receive a fast-acting BRAF inhibitor called Dabrafenib in the first instance. They then receive the checkpoint inhibitor known as Ipilimumab when the cancer adapts and progresses.

“While some patients’ symptoms necessitate a BRAF inhibitor upfront, most are well enough to take Ipilimumab first, with Dabrafenib in reserve”, Dr Gedye and Professor Boyle wrote.

“Our clinical experience and two international case series reinforce that administering Implimumab then a BRAF inhibitor is very likely to be superior.”

As well as the improvement in clinical outcomes, economically, increasing the choice of medication regimen could save money.

Dabrafenib costs A$8759 per month and the average duration of therapy is 9.4 months. The Australian price of Ipilimumab is potentially up to A$190 000 per patient, with the 2014 year-to-September PBS cost being over $68 million.

“We assume most of the approximately 1500 Australian patients who will die with metastatic melanoma every year accept treatment”, Gedye and Boyle wrote. “Forty-six per cent of these patients have BRAF-mutated melanoma and of these, 85% are well enough to defer treatment with a BRAF inhibitor.

“Thus, about 585 patients receive a potentially inferior treatment sequence, and around $36 million per annum of otherwise effective treatment is administered inefficiently.

“We argue that, until randomised trials identify inferior or superior sequences, Australian melanoma patients and taxpayers would benefit from flexibility in prescribing these breakthrough treatments.”

Read the full letter on the Medical Journal of Australia website here.

The Medical Journal of Australia is a publication of the Australian Medical Association.