BRAF+ melanoma: first-line anti-PD-1 therapy tops MAPK inhibitors for OS

  • Schilling B & al.
  • Cancer Immunol Immunother
  • 26 Feb 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Results from a multicenter, retrospective study suggest that first-line (1L) anti-programmed death 1 (PD-1) therapy is associated with longer OS compared with MAPK inhibitors in patients with BRAF-mutated advanced melanoma.

Why this matters

  • This multicenter analysis fills the gap left by lack of head-to-head trials.

Key results

  • Patients treated with anti-PD-1 monotherapy had longer median OS compared with patients treated with MAPK inhibitors (29.1 vs 12.4 months; P<.001 style="list-style-type:circle;">
  • 26.6 vs 18.6 months in patients with normal lactase dehydrogenase (LDH) levels (P<.001>
  • 18.2 vs 9.2 months in patients with elevated LDH levels (P=.019).
  • Elevated LDH (HR, 2.1; P=.000), metastatic pattern (HR, 3.0; P=.000), and frequency of peripheral eosinophils (HR, 0.6; P=.005) were associated with survival.
  • Patients with 2-3 favorable markers (normal LDH, no visceral metastasis other than lung, eosinophil count >1.5%) showed superior OS when receiving anti-PD-1 compared with MAPK inhibition (P<.001 whereas os was similar in patients with favorable markers after stratification by first-line therapy.>

    Study design

    • 301 patients with unresectable/metastatic, BRAF-mutant melanoma, 106 treated with anti-PD-1 monotherapy (61.9% pembrolizumab, 38.1% nivolumab) and 195 with combined MAPK inhibitors (80.5% dabrafenib plus trametinib, 19.5% vemurafenib plus cobimetinib), were analyzed for survival.
    • Funding: None.

    Limitations

    • Retrospective study.
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