Outcomes of Advanced Malignant Melanoma in a South African Public Health Sector Cohort: The Urgent Need for Effective Therapy

Background Immunotherapy and molecularly targeted therapy have revolutionised the treatment of malignant melanoma, however for South Africa’s public health sector patient population, these treatment modalities are far out of reach and chemotherapy remains the only treatment option. Aim To evaluate the outcomes of advanced melanoma and determine the need for therapies other than conventional chemotherapy in South Africa’s public health sector. Setting The Department of Medical Oncology, Steve Biko Academic hospital (SBAH), Pretoria, South Africa. Methods Files of patients with advanced malignant melanoma managed at SBAH, from 01 January 2009 to 31 December 2019 were retrospectively reviewed. Results One hundred files meeting the inclusion criteria were analysed, 24 with regional (stage III) and 76 with metastatic (stage IV) disease. 23 (96%) patients with regional disease didn’t receive adjuvant therapy and had a median time to progression (mTTP) of 12 months (95%CI; 8.9-15.0). Within the metastatic melanoma cohort, 34 (79.1%) patients received chemotherapy and had a median overall survival (mOS) of 5 months (95% CI; 4.3-5.6), while patients that didn’t receive chemotherapy had a mOS of 2 months (95% CI; 0.8-3.1) (p=0.213). Conclusion These results reaffirm the impotent effects of chemotherapy in treating malignant melanoma and it is imperative that South Africa’s public health sector expands its armamentarium against this lethal disease.