BRAF-Mutant Melanoma Field Continues to Move Forward

Source: Oncology Nursing News, June 2020

Efforts are being made to address remaining questions in the realm of BRAF-mutant melanoma, according to Charles L. Sawyers, MD. Areas of interest include determining the effectiveness of adding immunotherapy to targeted therapy and whether intermittent dosing of BRAF/MEK inhibitor combinations might yield more benefit than continuous dosage.

The phase 3 IMspire150 trial enrolled treatment-naïve patients with BRAF V600–mutant advanced melanoma. Patients were treated with atezolizumab (Tecentriq) in combination with vemurafenib (Zelboraf) and cobimetinib (Cotellic). Results presented at the 2020 AACR Annual Virtual Meeting I showed that the triplet regimen significantly improved progression-free survival (PFS) and produced durable responses versus vemurafenib and cobimetinib alone.1 The investigator-assessed median PFS with the triplet regimen was 16.1 months (95% CI, 11.3-18.5) versus 12.3 months (95% CI, 10.8-14.7) with vemurafenib/cobimetinib alone (log-rank, P = .1607); the benefit was observed across all prognostic subgroups.

Although this trial was positive, and the comparison that was made was very intriguing at the time that the trial was in development, the field has rapidly evolved. Now, the standard treatment for this patient population has become immunotherapy alone, either in the form of a CTLA-4 inhibitor or PD-L1 or PD-1 antibodies. “[Data reported on this approach showed that] 40% of the patients had PFS out to 5 years,” said Sawyers. “It would be hard to beat that with the data we saw presented at the [2020 AACR Virtual Meeting I] from the combination trial.”

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