Managing Brain Mets in Melanomac
Source: OncLive, February 2019
Transcript:
Michael A. Davies, MD, PhD: I think that the results that we’ve seen with ipilimumab and nivolumab in patients with brain metastases are remarkable. In both the CheckMate204 study published in the New England Journal of Medicine and the ABC study published in The Lancet Oncology, ipilimumab and nivolumab had intracranial response rates between 45% and 60%. Again, to your point, what was also impressive about it was the fact that in contrast to what we saw with dabrafenib and trametinib, almost all of those responses are lasting for at least 1 year and potentially even longer.
One of the things to keep in mind is that those patients who were enrolled in those studies weren’t on steroids. And so in the real world, where we see patients with cerebral edema who are on steroids, we actually don’t have data for immunotherapy. In the ABC trial, those patients actually were not allowed to have had previous radiation to the brain. For a patient who meets the criteria we saw in those trials, I do think that ipilimumab-nivolumab looks like the standard of care for patients who have brain metastases. But I think we’re also learning about how we handle patients, again, who are on steroids, who need sort of quick control. The disease control rate was much better with dabrafenib-trametinib than it was with the immunotherapy regimens.
Axel Hauschild, MD: Caroline, where do you still see a role for BRAF and MEK inhibitors in the brain metastases patient population? What is a clear signal for you to go with the BRAF-MEK regimen first, and not the immuno-oncology combination?