Melanoma             Physician Report




                      Melanoma Treatment Goals, Influences
                     ...
Melanoma             Physician Report


                                       Report Index


       Report Module        ...
Melanoma             Patient Flow




                     Patient Flow in Melanoma




May 2010 | Slide 3         2009 Me...
Melanoma                Patient Flow

                             Melanoma Makes Up Only a Small Portion
                ...
Melanoma               Patient Flow

               Frequency of Patient Visits Increases with Disease Severity
          ...
Melanoma               Patient Flow

             Frequency of Patient Visits Increases with Disease Severity
            ...
Melanoma             Patient Flow


                       Conclusions on Patient Flow in Melanoma


•    Physicians who t...
Melanoma             Treatment Drivers




                     Factors Driving the Selection of Treatment
               ...
Melanoma                       Treatment Drivers

                                         Efficacy is the Most Important ...
Melanoma             Treatment Drivers

  Recommendations for Sentinel Lymph Node Biopsy Are Primarily for
               ...
Melanoma               Treatment Drivers

     Lymph Node Involvement Is a Very Important Consideration for the
          ...
Melanoma             Treatment Drivers

   Incidence of Ulcerated Lesions in Melanoma increases With Disease
             ...
Melanoma                Treatment Drivers

   Ulceration Status Is an Important Consideration for the Treatment of
       ...
Melanoma             Treatment Drivers

Conclusions on Factors Driving the Selection of Treatment Options for
            ...
Melanoma             Adjuvant




                      Current Practices and Attitudes of Adjuvant
                      ...
Melanoma             Adjuvant

                                                       Interferon is the Primary Adjuvant T...
Melanoma               Adjuvant


                                 No Overriding Reason for NOT Offering Adjuvant Interfer...
Melanoma              Adjuvant

    Overall Usage of Adjuvant Interferon in Melanoma Increases with
  Disease Severity and...
Melanoma                 Adjuvant

                                                         Patients’ Fear of Side Effects...
Melanoma             Adjuvant

                      Conclusions on Current Practices And Attitudes of
                   ...
Melanoma             Treatment Practices




                      Aggregate Treatment Practices for Melanoma




May 2010...
Melanoma                Treatment Practices

         Following Surgical Excision, Observation is Primarily Used for
     ...
Melanoma                  Treatment Practices

             Treatment Modality Used for Metastatic (Stage IV) Melanoma
   ...
Melanoma             Treatment Practices


           Conclusions on Aggregate Treatment Practices for Melanoma

• For mel...
Melanoma             Referrals




                      Patient Referral Practices in Melanoma




May 2010 | Slide 25   ...
Melanoma                Referrals


                 Each Medical Specialty Has Its Own Referral Pattern in Melanoma

    ...
Melanoma               Referrals

        Number of Lines of Treatment Before Referral Is Highly Specific to
             ...
Melanoma                Referrals

Multiple Lines of Treatment Are Typically Tried Before Referral in Stage
              ...
Melanoma               Referrals

   Stage III and IV Melanoma Patients Are Typically Referred to Medical
            Onco...
Melanoma               Referrals

     Main Reason Melanoma Patients Are Referred Are to Participate in
                  ...
Melanoma             Referrals


                  Conclusions on Patient Referral Practices in Melanoma


•     Overall a...
Melanoma             Clinical Trials




                 Factors Driving U.S. Clinical Trial Participation
              ...
Melanoma              Clinical Trials


             Factors Driving U.S. Clinical Trial Participation in Melanoma

      ...
Melanoma                 Clinical Trials

              Vaccine Therapies Are Most Expected to Have the Greatest Future
  ...
Melanoma             Clinical Trials

         Conclusions on Factors Driving U.S. Clinical Trial Participation
          ...
Melanoma            Methodology




                      Survey Methodologies and Demographics




May 2010 | Slide 36   ...
Melanoma             Methodology

                           Stats Summary: 2009 Semi-Annual Survey on
                   ...
Melanoma




                    The material in this report is restricted to non-commercial
                    activitie...
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M Doutlook 2009 Melanoma Physicians Report

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Recent results about Clinical practices in the US for Melanoma

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M Doutlook 2009 Melanoma Physicians Report

  1. 1. Melanoma Physician Report Melanoma Treatment Goals, Influences and Treatment Practices in the U.S. Differential Practices Among Medical Oncologists, Dermatologists, Surgical Oncologists & Radiation Oncologists Source: MDOUTLOOK 2009 Semi-Annual Survey on Melanoma May 2010 | Slide 1 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  2. 2. Melanoma Physician Report Report Index Report Module Slide • Patient Flow in Melanoma 3 • Factors Driving the Selection of Treatment Options for Melanoma 8 • Current Practices and Attitudes of Adjuvant Treatment 15 • Aggregate Treatment Practices for Melanoma 21 • Patient Referral Practices in Melanoma 25 • Clinical Trials & New Therapeutic Options in Melanoma 32 • Survey Methodologies and Demographics 36 May 2010 | Slide 2 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  3. 3. Melanoma Patient Flow Patient Flow in Melanoma May 2010 | Slide 3 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  4. 4. Melanoma Patient Flow Melanoma Makes Up Only a Small Portion of Most Treaters’ Practices Proportion of Practice Involving Melanoma Proportion of Practice 8% 0% 3% 1-10% 3% 3% 4% 11-20% 21-30% 0.4% 31-40% 10% 2% 41-50% 0% >50% MedOnc >50% HemOnc 1% 4% 72% >50% Derm >50% RadOnc >50% SurgOnc Key Conclusions Additional Information • For most survey respondents, melanoma • Includes all stages of disease patients make up only a small portion of their • Includes all medical specialties: practice • MedOnc (n=121), HemOnc (n=55), Derm • ~10% of practices are specifically focused on (n=38), RadOnc (n=16), SurgOnc (n=23) melanoma • Mostly either Medical or Surgical Oncologists May 2010 | Slide 4 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  5. 5. Melanoma Patient Flow Frequency of Patient Visits Increases with Disease Severity During the 1st Year of Treatment Overall Frequency of Patient Visits During 1st Year of Treatment Onc Derm RadOnc SurgOnc 1.5 Avg. # Patient visits / month 1.25 1 0.75 0.5 0.25 0 Stage IA/IB/IIA Stage IIB/C Stage IIIA Stage IIIB/C Stage IV Key Conclusions • Most medical specialists will see their melanoma patients with increasing frequency as disease progresses • Surgical oncologists are pretty consistent at ~1.25 x / month • Patients with early melanoma are typically seen quarterly or semi-annually during the 1st year • Patients with advanced melanoma average monthly visits during their 1st year of treatment May 2010 | Slide 5 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  6. 6. Melanoma Patient Flow Frequency of Patient Visits Increases with Disease Severity During Five Years of Follow-up Frequency of Patient Visits During 5 Years of Follow-up Onc Derm RadOnc SurgOnc 10 8 Avg. # Patient visits / year 6 4 2 0 Stage IA/IB/IIA Stage IIB/C Stage IIIA Stage IIIB/C Stage IV Key Conclusions • Most medical specialists will see their melanoma patients with increasing frequency as disease progresses • Oncologists (medical + hematologic) are most likely to keep the closest follow-up with their melanoma patients, especially those with metastatic disease May 2010 | Slide 6 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  7. 7. Melanoma Patient Flow Conclusions on Patient Flow in Melanoma • Physicians who treat melanoma patients typically see a broad array of other malignancies • Melanoma comprises only a small portion of physician practices • There is a small subset of 10% of physicians, mostly medical and surgical oncologists, who specifically focus on melanoma. >50% of their practice consists of melanoma patients • Frequency of melanoma patient visits is strongly dependent on disease stage • Stage I & II melanoma is initially seen a couple of times each quarter with occasional follow-up over the next 5 years • Patients with stage III melanoma are seen many times each quarter with regular, quarterly follow-up • Stage IV melanoma is closely monitored, ~1x/month during treatment and with every 1-2 months during follow-up periods • Regular follow-up during the 5 years after treatment is performed by almost all melanoma treaters, regardless of the stage of disease May 2010 | Slide 7 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  8. 8. Melanoma Treatment Drivers Factors Driving the Selection of Treatment Options for Melanoma Including: Incidence and Importance Of Sentinel Lymph Node Biopsy & Lesion Ulceration May 2010 | Slide 8 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  9. 9. Melanoma Treatment Drivers Efficacy is the Most Important Driver of Treatment Selections for Melanoma Importance of Various Factors on Treatment Decisions in Melanoma 10 Most Important 8.09 6.90 6.71 6.53 8 Onc 5.80 5.33 5.07 4.84 4.70 3.68 (n=147) Average Ranking 6 Derm (n=30) 4 RadOnc (n=13) 2 SurgOnc Least (n=18) Important 0 Efficacy Performance Safety Tolerability Co-morbidity Patient Payer Age Availability Administration status preference coverage / Cost Key Conclusions Additional Information • Efficacy is the main driver of treatment decisions in melanoma • Overall score for each o Administration (route, schedule, etc) is seen as the least reason in shown above important factor each set of bars • Radiation oncologists are more concerned with safety and • Includes all disease stages tolerability than other medical specialties May 2010 | Slide 9 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  10. 10. Melanoma Treatment Drivers Recommendations for Sentinel Lymph Node Biopsy Are Primarily for Stages II & III Melanoma Overall Proportion of Melanoma Patients For Biopsy by Disease Stage 80% recommended to have LN biopsy Proportion of melanoma patients 60% 40% 20% 0% Stage IA/IB Stage IIA Stage IIB/C Stage IIIA Stage IIIB/C Stage IV Key Conclusions Additional Information • Most melanoma patients with stage II and stage III melanoma • Includes all medical specialties are recommended to have their sentinel lymph nodes biopsied • Calculated from % of patients • Probably includes those who have already had SLN recommended to have biopsy biopsies • IIIA data may represent max % ever • Sentinel lymph node biopsies are NOT routinely recommended to have SLN biopsy for most patients with earliest and malignant forms of melanoma May 2010 | Slide 10 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  11. 11. Melanoma Treatment Drivers Lymph Node Involvement Is a Very Important Consideration for the Treatment of Melanoma Overall Importance of Lymph Node Involvement 4% 2% 11% Additional Information • Importance as to treatment decision &/or Extremely important decision to refer 46% Very important • Lymph node involvement includes number Somewhat important of nodes, number of sites, or the combination Not very important Not at all important • Includes all medical specialties combined • Includes all stages of disease 37% Key Conclusions • Almost ½ of melanoma treaters see lymph node involvement as “Extremely” important to treatment / referral decisions • Additional 1/3 rate LN involvement as “Very” important • Very few melanoma treaters see lymph node involvement as being unimportant to treatment decisions May 2010 | Slide 11 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  12. 12. Melanoma Treatment Drivers Incidence of Ulcerated Lesions in Melanoma increases With Disease Progression Overall Incidence of Ulcerated Melanoma Lesions by Disease Stage 40% Proportion of patients with ulcerated lesions 30% 20% 10% 0% Stage IIB/C Stage IIIA Stage IIIB/C Key Conclusions Additional Information • ~1/6 of patients with stage II B/C melanoma have ulcerated lesions • Includes all medical • ~1/4 of patients with stage III A melanoma lesions have ulcerated specialties lesions • Calculated from the • ~ 1/3 of patients with stage III B/C melanoma have ulcerated proportion of patients with lesions ulcerated patients May 2010 | Slide 12 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  13. 13. Melanoma Treatment Drivers Ulceration Status Is an Important Consideration for the Treatment of Melanoma Overall Importance of Lesion Ulceration 4% to Treatment Selection 7% 28% Additional Information • Respondents were instructed to consider Extremely important the importance of ulceration status “in and Very important of itself” 26% Somewhat important • Includes all medical specialties combined Not very important • Includes all stages of disease Not at all important 35% Key Conclusions • The ulceration of melanoma lesions is a “very important” consideration for ~1/3 of treaters when deciding on a treatment regimen • Ulceration is an “extremely important” treatment consideration for >1/4 of melanoma treaters • Very few melanoma treaters see ulceration status as being unimportant to treatment decisions May 2010 | Slide 13 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  14. 14. Melanoma Treatment Drivers Conclusions on Factors Driving the Selection of Treatment Options for Melanoma • Efficacy is the key overall driver of treatment considerations for melanoma • Radiation oncologists are also very concerned with safety and tolerability of the treatment options they use • Sentinel lymph node biopsies are consistently recommended for stage II and stage III melanoma and are a strong driver of a treater’s decision on treatment / referral • SurgOncs percentage probably reflects the overall acceptance of SLN biopsy by this group • Ulcerated lesions increase in frequency as melanoma progresses but still represents only a minority (~1/3) of clinical cases by stage III disease • Lesion ulceration plays a very important consideration for most melanoma treaters when deciding on the treatment plan May 2010 | Slide 14 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  15. 15. Melanoma Adjuvant Current Practices and Attitudes of Adjuvant Treatment in Melanoma May 2010 | Slide 15 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  16. 16. Melanoma Adjuvant Interferon is the Primary Adjuvant Therapy Offered in Melanoma By Type of Adjuvant Therapy By Disease Stage IIB/C IIIA IIIB/C Observation IFN Clinical Trial 60% 60% Overall Proportion of Patients Receiving 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% Observation IFN Clinical Trial IIB/C IIIA IIIB/C Adjuvant Treatment Melanoma Stage Key Conclusions • Use of adjuvant interferon increases with disease severity • Some type of adjuvant therapy is offered to most patients with stage IIB/C through IIIB/C • Adjuvant interferon is the dominant choice for adjuvant therapy, especially in stage III disease May 2010 | Slide 16 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  17. 17. Melanoma Adjuvant No Overriding Reason for NOT Offering Adjuvant Interferon Therapy Overall Reasons for Not Offering Adjuvant Therapy Onc Derm RadOnc SurgOnc (n=156) (n=18) (n=12) (n=22) 60% Key Conclusions • In general, no single reason dominates a physician’s 50% decision to NOT offer interferon as an adjuvant treatment in Overall Proportion of Patients stages IIb & III melanoma 40% • Each reason is relatively equally faced by all medical specialties 30% • Surgical oncologists proportionally have/report more reasons for not offering adjuvant interferon 20% • Patients’ ability to handle the interferon (PS and co- morbidities) are slightly more common as a reason for not 10% offering adjuvant interferon 0% Additional Information • Calculated from the % patients for whom each physician has that reason • Individual respondents’ totals did not have to equal 100%, representing the fact that multiple reasons may exist • “Onc” includes medical & hematologic oncologists Reasons Selected May 2010 | Slide 17 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  18. 18. Melanoma Adjuvant Overall Usage of Adjuvant Interferon in Melanoma Increases with Disease Severity and is Mostly Consistent Across Medical Specialties IIB/C IIIA IIIB/C 70% 60% Receiving Adjuvant IFN Proportion of Patients 50% 40% 30% 20% 10% 0% Total Onc Derm RadOnc SurgOnc (n≥152) (n ≥19) (n ≥13) (n ≥20) Key Conclusions Additional Information • Usage of adjuvant interferon increases with disease • Overall usage calculated severity, regardless of medical specialty from median proportion of • Overall pattern and amount of adjuvant interferon usage in melanoma patients receiving adjuvant is similar across medical specialties IFN • 1 exception: lower usage with Surgical oncologists in stage IIB/C May 2010 | Slide 18 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  19. 19. Melanoma Adjuvant Patients’ Fear of Side Effects is a Key Reason Adjuvant Interferon is Not Used Reasons Given By Patients* for Not Using Adjuvant Interferon 50% Overall Proportion of Patients 40% 30% 20% 10% 0% Cost / Financial Do not think Fear of side Induction Inconvenience No specific considerations adjuvant effects schedule not of dosing reason given therapy is feasible schedule needed Reasons Given * As reported by the physicians Key Conclusions Additional Information • Reason most commonly given to NOT use Adjuvant Interferon was a • Individual respondents’ totals fear of side effects did not have to equal 100%, representing the fact that • Most physicians have some patients who give each of these reasons multiple reasons may exist for not using adjuvant interferon • Includes responses from all medical specialties combined May 2010 | Slide 19 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  20. 20. Melanoma Adjuvant Conclusions on Current Practices And Attitudes of Adjuvant Treatment in Melanoma • For earlier stage IIB/C melanoma patients, no standard practice exists for offering adjuvant therapy. Only a minority are offered or take adjuvant interferon • Adjuvant interferon is commonly used for many stage III (A and B/C) melanoma patients - Interferon is the PRIMARY adjuvant treatment being OFFERED by physicians • NOT offering adjuvant interferon treatment occurs for many divergent reasons, but the patient’s ability to handle the treatment is the top reason • Various medical specialties are mostly similar in their rationale • Overall usage of adjuvant interferon in melanoma increases with disease severity and is mostly consistent across medical specialties • Patients – as reported by physicians - appear to be most afraid of the potential side effects when receiving adjuvant interferon May 2010 | Slide 20 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  21. 21. Melanoma Treatment Practices Aggregate Treatment Practices for Melanoma May 2010 | Slide 21 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  22. 22. Melanoma Treatment Practices Following Surgical Excision, Observation is Primarily Used for Stages IA – IIA; Adjuvant Interferon is Added for Stage III Melanoma Interferon Usage Vs. Observation Following Surgery / Excision Across All Stages of Melanoma 125% 100% % 75% Adjuvant IFN Physician Observation usage 50% Adjuvant IFN % Patient Observation receiving 25% 0% IA (n=129) IB (n=120) IIA (n=121) IIB/C (n=126) IIIA (n=137) IIIB/C IV m1ab IV m1c (n=135) (n=152) (n=153) Key Conclusions Additional Information • After surgical excision of melanoma • % of patients receiving each modality is strongly lesions, observation is the standard of care for correlated with the % of physicians using that therapy stages IA – IIA • These are the main treatment choices of • The addition of adjuvant IFN is the main protocol physicians for stages I – III melanoma for stage III disease • Still, not every patient will be treated the same • Relatively even split between observation and way adjuvant IFN for stage IIB • As expected, surgical excision in not used for stage IV May 2010 | Slide 22 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  23. 23. Melanoma Treatment Practices Treatment Modality Used for Metastatic (Stage IV) Melanoma Is Not Dependent on Location of Metastases Systemic Therapy Usage in Stage IV Melanoma 100% 80% Biochemotherapy Chemotherapy % Physician 60% Immunotherapy usage Targeted agents (e.g. TKI inhibitors) 40% Biochemotherapy Chemotherapy % Patient 20% Immunotherapy receiving Targeted agents (e.g. TKI inhibitors) 0% M1a/b M1c Key Conclusions Additional Information • Chemotherapy is the main treatment modality for • % of patients receiving each modality is metastatic melanoma strongly correlated with the % of • Presence of metastases at visceral or distant sites physicians using that therapy (M1c) has little effect on the treatment modalities used • Physicians are comfortable with their general approach to treat stage IV melanoma May 2010 | Slide 23 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  24. 24. Melanoma Treatment Practices Conclusions on Aggregate Treatment Practices for Melanoma • For melanoma stages I through III, surgical excision of the lesion is the main treatment modality used for treatment – Stage IIB is the inflection point between following surgery with either observation alone or adjuvant IFN • For stages I – IIA, observation is the main follow-up approach • For stage III, adjuvant IFN is the main follow-up approach • Chemotherapy is the main approach used to treat stage IV (metastatic) melanoma – However, much lower level of consensus, especially outside of the oncologists, suggesting an effective, widely-accepted standard of care does not exist for this stage May 2010 | Slide 24 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  25. 25. Melanoma Referrals Patient Referral Practices in Melanoma May 2010 | Slide 25 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  26. 26. Melanoma Referrals Each Medical Specialty Has Its Own Referral Pattern in Melanoma Overall Referral Amounts by Medical Specialty 100% Melanoma Patients Referred 80% IA/IB/IIA Overall Percentage of 60% IIB/C 40% IIIA IIIB/C 20% IV 0% Onc Derm RadOnc SurgOnc (n=148) (n=36) (n=12) (n=20) Key Conclusions Additional Information • Each medical specialty has its own referral pattern in melanoma • Calculated from the range of • Amount of referral for oncologists is consistent and independent of disease patients referred at each disease stage stage • For dermatologists and Surgical oncologists, the amount of referral increases with disease severity • “Onc “includes both Medical and • Slight reduction in referral amounts for radiation oncologists with disease Hematologic oncologists progression • Implies that derms function as “gatekeepers” for melanoma treatment May 2010 | Slide 26 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  27. 27. Melanoma Referrals Number of Lines of Treatment Before Referral Is Highly Specific to Medical Specialty Referral of Melanoma Patients by Line of Treatment 5 4 IA/IB/IIA Average Line of Treatment Before Referring IIB/C 3 IIIA 2 IIIB/C 1 IV 0 Onc Derm RadOnc SurgOnc (n=124) (n=33) (n=11) (n=20) Key Conclusions Additional Information • Oncologists will consistently try 1.5 – 2.5 lines of treatment • Calculated from the line of treatment before referring a melanoma patient, regardless of disease when referral typically occurs stage • Future studies will need to link this • Derms and SurgOncs will repeated treat early stage info with the treatment referred for melanoma but rapidly refer later stage patients • Radiation is rarely given in successive lines of treatment May 2010 | Slide 27 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  28. 28. Melanoma Referrals Multiple Lines of Treatment Are Typically Tried Before Referral in Stage I & II Melanoma Referral of Melanoma Patients by Line of Treatment 5 4 Average Line of Treatment Onc (n=124) Before Referring 3 Derm (n=33) 2 RadOnc (n=11) SurgOnc (n=20) 1 0 Stage IA/IB/IIA Stage IIB/C Stage IIIA Stage IIIB/C Stage IV Key Conclusions Additional Information • With stage I / IIA melanoma, most treaters will try multiple • Calculated from the line of treatment when lines of therapy before referring a patient referral typically occurs • At stage IIB/C, dermatologists join RadOncs as early • Future studies will need to link this info with referrers the treatment referred for • For stage III and IV melanoma, most referrals occur before 2nd line of treatment May 2010 | Slide 28 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  29. 29. Melanoma Referrals Stage III and IV Melanoma Patients Are Typically Referred to Medical Oncology ThoughtLeaders for Additional Treatment Primary Referral Target 60% MedOnc 50% Derm / DermOnc Physician Respondents 40% Academic MedOnc / 30% ThoughtLeader Academic DermOnc / ThoughtLeader 20% SurgOnc 10% RadOnc 0% Plastic Surgeon Stage IA/IB/IIA Stage IIB/C Stage IIIA Stage IIIB/C Stage IV (n=167) (n=183) (n=189) (n=199) (n=217) Key Conclusions Additional Information • Early stage I & IIA melanoma patients are primarily referred to • Top selection per stage only dermatologists and surgical oncologists for treatment • Limited to those who refer melanoma • MedOnc ThoughtLeaders are referred stage III and IV patients for treatment melanoma patients most often, although some physicians • Includes all medical specialties send these patients to community oncologists combined • Limited use of plastic surgeons and radiation oncologists for referral May 2010 | Slide 29 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  30. 30. Melanoma Referrals Main Reason Melanoma Patients Are Referred Are to Participate in Clinical Trials Reasons for Melanoma Referrals 10% Clinical trial participation 7% 30% Additional Information Local ThoughtLeader available • Includes all disease stages Disease stage • Includes all medical specialties 10% combined Disease progression • Physicians could select top 3 choices Patient preference 12% Proficiency required 18% Other* Other* includes : Availability, Co-morbidity / 13% PS, Age, and Side effects Key Conclusions • Clinical trial participation is the top reason melanoma treaters refer patients to other physicians • Local ThoughtLeader usage is the 2nd most important reason for patient referral • “Treatment side effects” was the least often selected reason for patient referral (by 2% of respondents) May 2010 | Slide 30 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  31. 31. Melanoma Referrals Conclusions on Patient Referral Practices in Melanoma • Overall amount of referrals in melanoma increase with disease severity with changes in the specialization of referral targets • However, oncologists refer about the same proportion of their melanoma patients across every stage of disease (~20%) • For stages I & II of melanoma, most physicians will try multiple lines of treatment before referring. Referral occurs sooner in stage III and IV disease. • Early stages of melanoma are typically referred to dermatologists or surgical oncologists for treatment. Advanced stages are referred to oncology ThoughtLeaders for additional treatment. • Type of referral target is key – referral for surgery many times is different than to begin systemic therapy • Top reasons for referral are for inclusion in a clinical trial and to be treated by a ThoughtLeader May 2010 | Slide 31 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  32. 32. Melanoma Clinical Trials Factors Driving U.S. Clinical Trial Participation & New Therapeutic Options in Melanoma May 2010 | Slide 32 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  33. 33. Melanoma Clinical Trials Factors Driving U.S. Clinical Trial Participation in Melanoma Melanoma Treaters' Reasons for Clinical Trial Participation Onc (n=176) Derm (n=38) RadOnc (n=16) SurgOnc (n=23) Physician Respondents (%) 80% 60% 40% 20% 0% Respondents could select top 3 choices Key Conclusions • Top drivers to match patient with specific trials are “Available Treatment Options” and “Patient's Eligibility” • Secondary reasons are: Advancing Medicine, Convenience of Location, and Results from Earlier Phase Trials (e.g. Phase I & II results drive Phase III recruitment) • Following drivers considered far less important: Drug Familiarity, Individualized Approach through Molecular Signature, and Reputation of Study Chairs • Relative importance of reasons are mostly consistent among medical specialties May 2010 | Slide 33 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  34. 34. Melanoma Clinical Trials Vaccine Therapies Are Most Expected to Have the Greatest Future Impact on Treatment of Melanoma Drugs Currently Under Investigation Expected to Impact Melanoma Treatment Protocols Onc (n=176) Derm (n=38) RadOnc (n=16) SurgOnc (n=23) 60% Physicians Selecting 50% 40% 30% 20% 10% 0% Most Least Important Important Key Conclusions Additional Information • For most medical specialties, vaccine therapy is expected to have the biggest • Respondents could make up to impact on melanoma treatment protocols 3 selections • In spite of the past 5 years worth of randomized data • “Onc” includes responses from • Little awareness of the two drugs that are likely to gain approval for metastatic medical & hematologic disease in near future oncologists • Surgical oncologists’ selections are very different from others May 2010 | Slide 34 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  35. 35. Melanoma Clinical Trials Conclusions on Factors Driving U.S. Clinical Trial Participation & New Therapeutic Options in Melanoma • Lack of available treatment options drive clinical trial participation • Vaccine therapies are expected by about half of melanoma treaters to have a significant impact of treatment protocols in the near future • Each medical specialty has its own distinct pattern of expectations about new drug treatments for melanoma – Surgical oncologists had the most individual selection pattern May 2010 | Slide 35 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  36. 36. Melanoma Methodology Survey Methodologies and Demographics May 2010 | Slide 36 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  37. 37. Melanoma Methodology Stats Summary: 2009 Semi-Annual Survey on Melanoma Distribution of Survey Respondents Background By Medical Specialty • Survey open ~6 weeks from October 27, 2009 and continued through to December 14, 2009 9% • 256 total respondents from 39 states 6% • Representation from multiple disciplines • Oncologist (Medical + Hematological) – 176 Onc (69%) 15% Derm • Dermatologist – 38 (15%) RadOnc • Radiation Oncologist – 16 (6%) SurgOnc • Surgical Oncologist – 23 (9%) • 98 respondents (~38%) were academic 70% • Includes “Specialty treatment centers” (i.e. MD Anderson, Mayo, etc.) and VA centers • Thirty-three (33) of the respondents were recognized by their peers as ThoughtLeaders May 2010 | Slide 37 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro
  38. 38. Melanoma The material in this report is restricted to non-commercial activities only. Distribution of these materials for educational purposes to colleagues, staff, or patients is freely allowed. PowerPoint slides of the information in this report for use in educational presentations are available and may be obtained upon request. Contact: survey@mdoutlook.com 888.3OUTLOOK | 888.368.8566 (North America) +1.404.496.4136 (International) © 2008-2010| MDoutlook, LLC – All rights reserved May 2010 Slide 38 2009 Melanoma Physician’s Report © MDOUTLOOK, LLC | Powered by The Arcas Gro

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