RESUMEN
Immune checkpoint inhibitors and targeted therapies have profoundly altered the management of several cancers over the past decade. Metastatic melanoma has been at the forefront of these changes. We provide here a nationwide overview and an assessment of changes in survival in France. We included 10,936 patients receiving a systemic treatment for metastatic cutaneous melanoma between 2010 and 2017 using the French National Health Insurance database (Système National des Données de Santé). Over the study period, there was a doubling of the number of new patients receiving a systemic treatment. Cytotoxic chemotherapy was progressively replaced by targeted therapy and immune checkpoint inhibitors. Patients having initiated a first-line treatment since June 2015 gained 46% overall survival compared with those initiating treatment before 2012. Overall survival at 24 months rose from 21% to 44%. We provide real-world evidence for the improvement of overall survival in the past decade among patients with metastatic melanoma. Although the characteristics of the patients treated can vary across periods, this type of exhaustive real-world data provides evidence from broader populations than those included in clinical trials.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Melanoma/mortalidad , Mortalidad/tendencias , Neoplasias Cutáneas/mortalidad , Reclamos Administrativos en el Cuidado de la Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Masculino , Melanoma/tratamiento farmacológico , Melanoma/secundario , Persona de Mediana Edad , Inhibidores de Proteínas Quinasas/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this report was to study the cause-specific mortality of French workers in the construction industry. METHODS: From a cohort of 12,788 male workers, standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were calculated for the years between 1974 and 1999 for workers aged 20 to 64 years. RESULTS: All-cause mortality was significantly increased (SMR=111, CI=106-206). Excess mortality was found for cancers (SMR=125, CI=117-134), especially for the oral cavity and pharynx (SMR=134, CI=108-163), digestive (SMR=120, CI=104-137) and respiratory (SMR=143, CI=128-159) systems; cerebrovascular disease (SMR=130, CI=106-158); diseases of the digestive system (SMR=130, CI=113-149), and accidental falls (SMR=158, CI=105-125). Excess risks were limited to blue-collar workers. CONCLUSIONS: Despite a probable role of lifestyle and potential limitations of the study, elevated mortality was observed for several causes possibly related to occupational factors.