Immunotherapy vs TKIs in BRAF+ Metastatic Melanoma

Source: OncLive, September 2019

Sanjiv S. Agarwala, MD: The metastatic melanoma has similar issues and discussions. And we’ll start with the whole BRAF and BRAF-mutant wild-type story. I’ll turn to you, Caroline, as well, to start this. [They’re similar debates. What do you choose? We don’t have randomized data to tell us which way to go. Let’s start with efficacy—efficacy of immunotherapy versus targeted therapy. Is there a difference in survival rates? Two years, 3 years? Whatever data we have, looking at the latest ASCO [American Society of Clinical Oncology Annual Meeting], [from] which 1 of the abstracts is yours.

Caroline Robert, MD, PhD: Yes, we have some results. We have long-term results. We know the response rate is much higher with BRAF/MEK than with anti–PD-1 [programmed cell death protein 1] monotherapy. And the difference is a bit smaller with anti–PD-1, but still 70% of response rate with anti-BRAF, anti-MEK for the first evaluations, usually very early responses. However, as we said before, we know that the curves cross each other at about 15 months, or after 15 months, and we have the PD-1 continuing curve that gets on top. So if you have the choice at the beginning, if you don’t have a patient with a very high tumor burden, and you’re afraid the patient is not going to be alive in 2, 3 months, usually we would initiate with immunotherapy.

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