Management of metastatic melanoma in Texas: disparities in the utilization of immunotherapy following the regulatory approval of immune checkpoint inhibitors.

Publication date: Jul 13, 2023

The utilization of modern-immunotherapies, notably immune checkpoint inhibitors (ICIs), has increased markedly in patients with metastatic melanoma over the past decade and are recommended as standard treatment. Given their increasing adoption in routine care for melanoma, understanding patient access to immunotherapy and patterns of its use in Texas is crucial as it remains one of the few states without Medicaid expansion and with high rates of the uninsured population. The objectives of this study were to examine the trend in the utilization of immunotherapy and to determine factors associated with immunotherapy utilization among patients with metastatic melanoma in the era of ICIs in Texas. A retrospective cohort study was conducted using the Texas Cancer Registry (TCR) database. The cohort comprised of adult (≥ 18 years) patients with metastatic melanoma diagnosed between June 2011 and December 2018. The trend in immunotherapy utilization was assessed by determining the proportion of patients receiving immunotherapy each year. The Average Annual Percent Change (AAPC) in immunotherapy utilization was assessed using joinpoint regression, while multivariable logistic regression was used to determine the association between patient characteristics and immunotherapy receipt. A total of 1,795 adult patients with metastatic melanoma were identified from the TCR. Immunotherapy utilization was higher among younger patients, those with no comorbidities, and patients with private insurance. Multivariable analysis showed that the likelihood of receipt of immunotherapy decreased with older age [(adjusted Odds Ratio (aOR), 0. 92; 95% CI, 0. 89- 0. 93, p = 0. 001], living in high poverty neighborhood (aOR, 0. 52; 95% CI, 0. 44 – 0. 66, p 

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Concepts Keywords
December Access
Immunotherapy Disparity
Increased Immune Checkpoint Inhibitors
June Immunotherapy
Texas Melanoma


Type Source Name
disease MESH melanoma
pathway KEGG Melanoma
disease MESH Cancer
pathway REACTOME Reproduction
disease MESH noma
disease MESH skin cancers
drug DRUGBANK Honey
drug DRUGBANK Coenzyme M
drug DRUGBANK Indoleacetic acid
drug DRUGBANK Gold
disease MESH amelanotic melanoma
drug DRUGBANK Serine
drug DRUGBANK Trestolone
disease MESH comorbidity
disease MESH uncertainty
drug DRUGBANK Methyprylon
drug DRUGBANK Trihexyphenidyl
disease MESH Death
disease MESH Metastasis
disease MESH lung cancer
drug DRUGBANK Ipilimumab
drug DRUGBANK Lauric Acid
drug DRUGBANK Pembrolizumab
disease MESH cervical cancers
drug DRUGBANK Bismuth subgallate
drug DRUGBANK Silver
disease MESH colorectal cancer
pathway KEGG Colorectal cancer

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