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Since RCTs do not always reflect real\u2010world prescribing, we interrogated established national databases to track prescribing of CPIs approved for first line treatment of metastatic melanoma patients in England since 2014 and determined patient outcomes associated with OS, as well as treatment\u2010related toxicity. Between April 2014 and March 2018, 5465 melanoma patients were diagnosed and treated with systemic anticancer therapy (SACT), 2322 of which received first\u2010line CPIs. There was good 3\u2010year OS concordance with RCT outcomes for ipilimumab (32%), ipinivo (56%) and nivolumab (51%), but OS was lower than expected for pembrolizumab (40%). Comparing patients prescribed ipinivo with those prescribed pembrolizumab, ipinivo\u2010treated patients were younger (88% vs 49% patients &lt;70\u2009years, <jats:italic>P<\/jats:italic> &lt;\u2009.001) and fitter (60% vs 38% patients with Eastern Cooperative Oncology Group [ECOG] performance status 0, <jats:italic>P<\/jats:italic> &lt;\u2009.0001). Emergency hospital admission rates from the earliest and last treatment dates were higher for patients prescribed ipinivo (37% and 55%) compared to those prescribed pembrolizumab (17% and 29%). The 30\u2010day mortality rates favoured ipinivo patients (3.8% ipinivo, 9.1% pembrolizumab, <jats:italic>P<\/jats:italic> &lt;\u2009.0001) and likely reflected marked differences in median treatment durations: 63 (range 7\u2010440) days for ipinivo and 192 (range 5\u2010943) days for pembrolizumab. The dominant treatment\u2010related condition linked to hospital admission was colitis, recorded for 25% of patients prescribed ipinivo compared to 4% of patients prescribed pembrolizumab. Our population data has demonstrated that RCT outcomes can be achieved in routine care settings with careful patient selection.<\/jats:p>","DOI":"10.1002\/ijc.33266","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T05:41:02Z","timestamp":1598334062000},"page":"868-875","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Metastatic melanoma patient outcomes since introduction of immune checkpoint inhibitors in England between 2014 and 2018"],"prefix":"10.1002","volume":"148","author":[{"given":"Ruth","family":"Board","sequence":"first","affiliation":[{"name":"Department of Oncology Lancashire Teaching Hospitals NHS Trust  Preston UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9642-0656","authenticated-orcid":false,"given":"Rebecca","family":"Smittenaar","sequence":"additional","affiliation":[{"name":"National Cancer Registration and Analysis Service, Health Improvement Directorate Public Health England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lawton","sequence":"additional","affiliation":[{"name":"National Cancer Registration and Analysis Service, Health Improvement Directorate Public Health England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanhua","family":"Liu","sequence":"additional","affiliation":[{"name":"National Cancer Registration and Analysis Service, Health Improvement Directorate Public Health England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bukky","family":"Juwa","sequence":"additional","affiliation":[{"name":"National Cancer Registration and Analysis Service, Health Improvement Directorate Public Health England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Oncology Royal Free London NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pippa","family":"Corrie","sequence":"additional","affiliation":[{"name":"Department of Oncology Cambridge University Hospitals NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1104621"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1412082"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503093"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709684"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910836"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-1023-4"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.12.017"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-018-0442-7"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx225"},{"key":"e_1_2_9_11_1","unstructured":"Guide to the processes of technology appraisal: Process and methods [PMG19].2014.https:\/\/www.nice.org.uk\/process\/pmg19\/chapter\/acknowledgements. 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