Dados do Trabalho

Título

IMMUNOTHERAPY TREATMENT IN ADVANCED MELANOMA IN THE PUBLIC HEALTH SYSTEM IN ONCOLOGY REFERENCE HOSPITAL IN SOUTHERN BRAZIL

Introdução

Cutaneous melanoma had an incidence of 324.535 new cases worldwide in 2020 and caused 57.043 deaths. The pathophysiology of melanoma is complex, and the development of new therapies has changed the survival and life quality of patients with advanced disease. Immunotherapy, especially with anti-PD-1 immune checkpoint inhibitors, has shown superior efficacy and overall survival gain in clinical studies when compared to chemotherapy with a better toxicity profile. In Brazil, chemotherapy is the only treatment option provided by the Public Health System (Sistema Único de Saúde - SUS) for patients with metastatic melanoma. Since 2019, the Centro de Pesquisas Oncológicas (CEPON) has offered treatment with pembrolizumab (anti-PD-1) for stage IV melanoma in alternative to chemotherapy. The treatment approval and financing are provided by institutional resources through a program called Administrative APAC.

Objetivo

To describe the therapeutic response, duration of clinical benefit and toxicity profile of treatment with pembrolizumab in a series of patients with clinical stage IV melanoma treated at CEPON through the administrative APAC program. To analyze the financial cost of treatment with pembrolizumab compared to dacarbazine and vemurafenib.

Método

Longitudinal and prospective study developed using data collected from medical records of medical appointments and exams. Cost analysis through purchase values of medicines provided by the CEPON pharmacy.

Resultado

Fourteen patients with advanced melanoma treated with pembrolizumab provided by the APAC administrative program were included. The median follow-up time for these patients was 9.2 months. At the end of the observation period, 7 patients were still under treatment, 2 patients discontinued treatment due to complete response and 5 patients due to disease progression. No patient developed serious adverse events (grades 3 and 4). Five patients developed immune-related adverse events. In comparative analysis, the median cost of
treatment with pembrolizumab was significantly higher than dacarbazine and significantly lower than vemurafenib.

Conclusão

This study describes the clinical evolution and the costs of treatment with pembrolizumab in patients with metastatic melanoma treated through the administrative APAC program. Patients treated with pembrolizumab had good therapeutic response with low toxicity, even in subsequent lines of treatment. The cost analysis confirmed the choice of the institution by pembrolizumab to replace vemurafenib.

Palavras-chave

melanoma; pembrolizumab; public health system