Thesis

Real-world outcomes in advanced melanoma : the impact of immunotherapy and targeted therapy

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Awarding institution
  • University of Strathclyde
Date of award
  • 2026
Thesis identifier
  • T17596
Person Identifier (Local)
  • 202074989
Qualification Level
Qualification Name
Department, School or Faculty
Abstract
  • The increasing global life expectancy has brought about a surge in age-related diseases, notably cancer, as cells accumulate mutations over time. Melanoma has witnessed a rise in diagnoses, with advanced melanoma accounting for 90% of skin cancer-related deaths. Before 2010, treatment options were limited, leading to a poor prognosis. However, the introduction of systemic anti-cancer therapy in the form of immunotherapy and targeted therapy revolutionised the outcomes for metastatic melanoma patients. This thesis focuses on the use of real-world evidence to explore the implications of systemic anti-cancer therapy for advanced melanoma patients. The research aims were reached through statistical and survival analysis techniques, including Kaplan-Meier estimates and Cox proportional-hazards models, to assess survival probabilities and analyse the impact of covariates on outcomes. Notably, time-dependency adjusted models were developed to explore the influence of body-mass index and therapy type on survival. A continuous time multi-state Markov model is used to investigate the treatment routes of advanced melanoma patients. The focus shifts to patients undergoing treatment changes between immunotherapy and targeted therapy, with particular emphasis on patients with progressive disease. This model provides valuable insights into the active treatment pathways in a real-world setting. A health economic evaluation is also introduced to this cohort, examining the cost effectiveness of advanced melanoma treatments. Using a state transition model, the study includes outcomes such as quality-adjusted life years and incremental cost-utility ratios in the cost-effectiveness analysis. The economic model's robustness is tested through a probabilistic sensitivity analysis. In conclusion, this thesis investigates the complexities of advanced melanoma treatments in a real-world setting. The findings contribute to a better understanding of treatment outcomes, paving the way for more informed clinical decisions and health policies in the ever-evolving landscape of cancer care.
Advisor / supervisor
  • Megiddo, Itamar
  • Barry, Sarah
  • Mueller, Tanja
  • Kleczkowski, Adam
Resource Type
DOI
Date Created
  • 2025

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