Metastatic Melanoma Gap Analysis

The CADTH pCODR Expert Review Committee (pERC) has issued reimbursement recommendations on immunotherapies (ipilimumab, pembrolizumab, nivolumab, and nivolumab plus ipilimumab) and BRAF mutation targeted therapies (dabrafenib plus trametinib, dabrafenib, vemurafenib, and vemurafenib plus cobimetinib) for the treatment of metastatic melanoma. Although the pERC recommendations specify the use of immunotherapies and BRAF-targeted therapies in specific metastatic melanoma patient populations, implementation issues and gaps not addressed in the recommendations or were out of scope have been identified by the Provincial Advisory Group (PAG). The objective of this review is to identify evidence that may address the implementation gaps identified by PAG. Specifically gaps such as the following:

• evidence informing the sequencing of BRAF-targeted therapies and immunotherapies for the treatment of patients with previously untreated BRAF mutation
• evidence informing the use of ipilimumab monotherapy times four doses after progression on first-line treatment with pembrolizumab or nivolumab for patients regardless of BRAF status
• evidence informing the use of nivolumab monotherapy as a first-line treatment option for patients with BRAF mutation.

An assessment of the strength and quality of the evidence identified will be performed.