1
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Aglietta M, Chiarion-Sileni V, Fava P, Guidoboni M, Depenni R, Minisini A, Consoli F, Ascierto PA, Rinaldi G, Banzi M, Marconcini R, Gueli R, Ferraresi V, Tucci M, Tonini G, Lo Re G, Guida M, Del Vecchio M, Marcon IG, Queirolo P. Outcomes in patients with BRAFV600-mutated melanoma and brain metastases at baseline treated with dabrafenib plus trametinib. TUMORI JOURNAL 2023; 109:537-545. [PMID: 37417313 DOI: 10.1177/03008916231179251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Brain metastases (BM) and lactate dehydrogenase (LDH) levels above the upper limit of normal (ULN) are associated with poor prognosis in patients with melanoma. Although treatment with the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib have demonstrated long-term clinical benefit in patients with melanoma, data on their efficacy in patients with BM are limited. METHODS DESCRIBE Italy is an observational, retrospective, real-world study evaluating dabrafenib plus trametinib in 499 patients with BRAFV600-mutant stage III unresectable or stage IV melanoma from various sites across Italy. Here, we analyzed the clinical outcomes for the subgroup of patients receiving first-line treatment and presenting with BM at diagnosis and assessed the impact of predictive factors such as LDH levels and the presence of other metastases on median progression-free survival (mPFS). RESULTS Overall, 325 evaluable patients were on first-line therapy and are the focus of this analysis; of these, 76 patients (23.4%) had BM at baseline. mPFS was lower for patients with BM at baseline compared with overall patients (8.7 months vs 9.3 months, respectively). Patients with BM at diagnosis and LDH >ULN had a considerably shorter mPFS compared with patients with LDH ⩽ULN (5.3 months vs 9.9 months, respectively). mPFS was noticeably longer for patients with cerebral metastases only compared with patients with cerebral and other metastases (15.0 months vs 8.7 months, respectively). CONCLUSIONS Dabrafenib plus trametinib showed effectiveness in a real-world population of patients with advanced BRAFV600-mutated melanoma and BM at baseline, supporting its use in this population with poor outcomes.
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Affiliation(s)
- Massimo Aglietta
- Department of Oncology, University of Torino, Torino, Italy
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Paolo Fava
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Piemonte, Italy
| | - Massimo Guidoboni
- Immunotherapy - Cell Therapy and Biobank, IRCCS-IRST, Meldola (FC), Italy
| | - Roberta Depenni
- Department of Oncology and Hematology, University Hospital of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Alessandro Minisini
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Francesca Consoli
- Department of Oncology, ASST Spedali Civili, Brescia, Lombardia, Italy
| | - Paolo Antonio Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Gaetana Rinaldi
- UOC Oncologia Medica Aoup Paolo Giaccone, Palermo, Sicilia, Italy
| | - Maria Banzi
- Oncology Unit, Presidio Ospedaliero Arcispedale Santa Maria Nuova AUSL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Riccardo Marconcini
- Presidio Ospedaliero S. Chiara - Az. Ospedaliero Universitaria Pisana, Pisa, Toscana, Italy
| | - Rossana Gueli
- Medical Oncology, ASST Sette Laghi, Circolo Hospital and Macchi Foundation, Varese, Lombardia, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Lazio, Italy
| | - Marco Tucci
- Department of Biomedical Sciences and Clinical Oncology, University of Bari, "Aldo Moro," Bari, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giovanni Lo Re
- Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto dei Tumori Giovanni Paolo II, Bari, Italy
| | - Michele Del Vecchio
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | | | - Paola Queirolo
- Oncology Division, Policlinico San Martino IRCCS, Genova, Liguria, Italy
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
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2
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Berking C, Livingstone E, Debus D, Loquai C, Weichenthal M, Leiter U, Kiecker F, Mohr P, Eigentler TK, Remy J, Schober K, Heppt MV, von Wasielewski I, Schadendorf D, Gutzmer R. COMBI-r: A Prospective, Non-Interventional Study of Dabrafenib Plus Trametinib in Unselected Patients with Unresectable or Metastatic BRAF V600-Mutant Melanoma. Cancers (Basel) 2023; 15:4436. [PMID: 37760406 PMCID: PMC10526829 DOI: 10.3390/cancers15184436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Combined BRAF/MEK-inhibition constitutes a relevant treatment option for BRAF-mutated advanced melanoma. The prospective, non-interventional COMBI-r study assessed the effectiveness and tolerability of the BRAF-inhibitor dabrafenib combined with the MEK-inhibitor trametinib in patients with advanced melanoma under routine clinical conditions. Progression-free survival (PFS) was the primary objective, and secondary objectives included overall survival (OS), disease control rate, duration of therapy, and the frequency and severity of adverse events. This study enrolled 472 patients at 55 German sites. The median PFS was 8.3 months (95%CI 7.1-9.3) and the median OS was 18.3 months (14.9-21.3), both tending to be longer in pre-treated patients. In the 147 patients with CNS metastases, PFS was similar in those requiring corticosteroids (probably representing symptomatic patients, 5.6 months (3.9-7.2)) compared with those not requiring corticosteroids (5.9 months (4.8-6.9)); however, OS was shorter in patients with brain metastases who received corticosteroids (7.8 (6.3-11.6)) compared to those who did not (11.9 months (9.6-19.5)). The integrated subjective assessment of tumor growth dynamics proved helpful to predict outcome: investigators' upfront categorization correlated well with time-to-event outcomes. Taken together, COMBI-r mirrored PFS outcomes from other prospective, observational studies and confirmed efficacy and safety findings from the pivotal phase III COMBI-d/-v and COMBI-mb trials.
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Affiliation(s)
- Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen—European Metropolitan Region Nürnberg, Friedrich-Alexander University (FAU), 91054 Erlangen, Germany;
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, and German Cancer Consortium (DKTK), Partner Site Essen, 45147 Essen, Germany; (E.L.); (D.S.)
| | - Dirk Debus
- Department of Dermatology, Nuremberg General Hospital—Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Carmen Loquai
- Department of Dermatology, Klinikum Bremen-Ost, Gesundheit Nord gGmbH, 28205 Bremen, Germany;
| | - Michael Weichenthal
- Department of Dermatology, Skin Cancer Center, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Felix Kiecker
- Department of Dermatology and Venereology, Vivantes Klinikum Berlin Neukölln, 12351 Berlin, Germany;
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, 21614 Buxtehude, Germany;
| | - Thomas K. Eigentler
- Department of Dermatology and Allergy, Skin Cancer Center Charité, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Janina Remy
- Novartis Pharma GmbH, 90429 Nuremberg, Germany; (J.R.); (K.S.)
| | | | - Markus V. Heppt
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen—European Metropolitan Region Nürnberg, Friedrich-Alexander University (FAU), 91054 Erlangen, Germany;
| | - Imke von Wasielewski
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany;
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, and German Cancer Consortium (DKTK), Partner Site Essen, 45147 Essen, Germany; (E.L.); (D.S.)
- Comprehensive Cancer Center (Westdeutsches Tumorzentrum), University Hospital Essen, Essen & National Center for Tumor Diseases (NCT); NCT-West, Campus Essen & Research Alliance Ruhr, Research Center One Health, University Duisburg-Essen, 45147 Essen, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, 44801 Minden, Germany;
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3
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Del Vecchio M, Chiarion Sileni V, Quaglino P, Rinaldi G, Minisini A, Troiani T, Consoli F, Sponghini A, Banzi M, Morelli MF, Palleschi D, Rossi E, Marconcini R, Depenni R, Carnevale-Schianca F, Marcon I, Queirolo P. The Pattern of Progression to First-Line Treatment with Dabrafenib and Trametinib in Patients with Unresectable or Metastatic, BRAF-Mutated, Cutaneous Melanoma: Results of the Observational T-WIN Study. Cancers (Basel) 2023; 15:cancers15071980. [PMID: 37046641 PMCID: PMC10093702 DOI: 10.3390/cancers15071980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
In patients with B-RAF-mutated cutaneous melanoma, targeted therapies are the treatment of choice to achieve a rapid response. In this multicentric, prospective, observational study, patients with B-RAF-mutated cutaneous melanoma who were treated with dabrafenib and trametinib were categorized in two cohorts (cohort A: limited disease (n = 104) and cohort B: bulky disease (n = 97)) according to lactate dehydrogenase levels. The primary endpoint was the progression pattern; the secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety data. From baseline to time of progression, there was a progression from nodal to other sites of disease in cohort A and from skin and nodal to other sites in cohort B. In both the cohorts, the number of involved organs and metastases at each location decreased. The median OS was 32.4 months (95% CI: 20.1 months (not estimable)) for cohort A, and 10.5 months (95% CI: 8.3–14.4 months) for cohort B; median PFS was 12.4 months (95% CI: 10.9–17.0 months) for cohort A, and 8.1 months (95% CI: 6.3–9.4 months) for cohort B. No new safety signals were reported. This study describes the patterns of first-line treatment progression with dabrafenib and trametinib in Italian clinical practice. The effectiveness and safety data were consistent with previous trials and extended to a real-world heterogeneous population.
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Affiliation(s)
| | | | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | | | - Teresa Troiani
- Unit of Dermatology, University of Campania Luigi Vanvitelli, 80123 Naples, Italy
| | | | - Andrea Sponghini
- AOU Maggiore della Carità, DIMET, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Maria Banzi
- Presidio Ospedaliero Arcispedale S. Maria Nuova AUSL di Reggio Emilia-IRCCS, 42123 Reggio Emilia, Italy
| | | | - Dario Palleschi
- Presidio Ospedaliero S. Maria di Ca’ Foncello Azienda ULSS 2, Marca Trevigiana, 31100 Treviso, Italy
| | - Ernesto Rossi
- Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Rome, Italy
| | - Riccardo Marconcini
- Presidio Ospedaliero S. Chiara, Azienda Ospedaliero Universitaria Pisana, 56100 Pisa, Italy
| | - Roberta Depenni
- Department of Oncology and Hematology, University Hospital of Modena and Reggio Emilia, 41121 Modena, Italy
| | | | | | - Paola Queirolo
- European Institute of Oncology-IRCCS, 20141 Milan, Italy
- Correspondence:
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4
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Safety of combining dabrafenib plus trametinib in elderly BRAF V600 mutation-positive advanced melanoma patients: real-world data analysis of Spanish patients (ELDERLYMEL). Melanoma Res 2022; 32:343-352. [PMID: 35762583 DOI: 10.1097/cmr.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Efficacy and safety of dabrafenib and trametinib in metastatic melanoma have been demonstrated in two-phase III and one-phase I/II clinical trials. However, patients at least 75 years old (y.o.) were largely underrepresented. Additionally, the safety profile of dabrafenib and trametinib based on age is unknown. ELDERLYMEL is a retrospective noninterventional multicenter study, describing the effectiveness and safety of at least 75 y.o. patients compared with less than 75 y.o. patients with advanced BRAF V600-mutated melanoma treated with dabrafenib plus trametinib or dabrafenib monotherapy. A total of 159 patients were included, 130 less than 75 y.o. and 29 at least 75 y.o. Clinical features were similar between the groups, except in the number of comorbidities, number of metastatic sites, Eastern Cooperative Oncology Group (ECOG) performance status, and BRAF V600-mutation type. Five patients per group received dabrafenib monotherapy. There were no differences in adverse events (AEs) rate or grade between the groups. However, AE profiles were different between the groups, being pyrexia infrequent in patients at least 75 y.o. (13.8% vs. 42.3%; P = 0.005). Dabrafenib and trametinib dose intensities were lower in at least 75 y.o. patients (P = 0.018 and P = 0.020), but there were no differences in effectiveness between the groups. Finally, in a multivariate analysis, sex (female) was the only variable independently associated with an increased risk of AE grade ≥3. Data from the ELDERLYMEL study demonstrate that dabrafenib plus trametinib is safe and effective in at least 75 y.o. patients with advanced BRAF V600-mutated melanoma without increasing toxicity. Additionally, we describe a different safety profile depending on age and sex.
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Rogala P, Czarnecka AM, Cybulska-Stopa B, Ostaszewski K, Piejko K, Ziętek M, Dziura R, Rutkowska E, Galus Ł, Kempa-Kamińska N, Calik J, Sałek-Zań A, Zemełka T, Bal W, Kamycka A, Świtaj T, Kamińska-Winciorek G, Suwiński R, Mackiewicz J, Rutkowski P. Long-Term Outcomes of Targeted Therapy after First-Line Immunotherapy in BRAF-Mutated Advanced Cutaneous Melanoma Patients—Real-World Evidence. J Clin Med 2022; 11:jcm11082239. [PMID: 35456332 PMCID: PMC9032972 DOI: 10.3390/jcm11082239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Currently, limited data on targeted therapy and immunotherapy sequencing in patients with BRAF-mutant melanoma is available. Targeted therapy and immunotherapy are expected to be comparable in terms of overall survival (OS) when used as second-line therapies; therefore, understanding the characteristics of patients who completed sequential treatment is needed. Methods: The primary objective of this study was to analyze the efficacy of BRAFi/MEKi activity as second-line therapy in patients with advanced melanoma. We also aimed to describe the clinical characteristics of patients with advanced melanoma who were treated sequentially with immunotherapy and targeted therapy. We enrolled 97 patients treated between 1st December 2015 and 31st December 2020 with first-line immunotherapy with programmed cell death 1 (PD-1) checkpoint inhibitors; and for the second-line treatment with at least one cycle of BRAFi/MEKi therapy with follow-up through 31 January 2022. Results: Median OS since first-line treatment initiation was 19.9 months and 12.8 months since initiation of BRAFi/MEKi treatment. All BRAFi/MRKi combinations were similarly effective. Median progression free survival (PFS) was 7.5 months since initiation of any BRAFi/MEKi treatment. Conclusions: BRAFi/MEKi therapy is effective in the second-line in advanced and metastatic melanoma patients. For the first time, the efficacy of all BRAFi/MEKi combinations as second-line therapy is shown.
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Affiliation(s)
- Paweł Rogala
- Department of Soft Tissue/Bone Sarcoma and Melansoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.R.); (K.O.); (T.Ś.); (P.R.)
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melansoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.R.); (K.O.); (T.Ś.); (P.R.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-546-24-55
| | - Bożena Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Kraków, Poland; (B.C.-S.); (K.P.); (A.S.-Z.); (T.Z.)
| | - Krzysztof Ostaszewski
- Department of Soft Tissue/Bone Sarcoma and Melansoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.R.); (K.O.); (T.Ś.); (P.R.)
| | - Karolina Piejko
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Kraków, Poland; (B.C.-S.); (K.P.); (A.S.-Z.); (T.Z.)
| | - Marcin Ziętek
- Department of Surgical Oncology, Wroclaw Comprehensive Cancer Center, 53-413 Wroclaw, Poland;
- Department of Oncology, Wroclaw Medical University, 50-376 Wroclaw, Poland
| | - Robert Dziura
- Department of Clinical Oncology, Holy Cross Cancer Center, 25-734 Kielce, Poland; (R.D.); (E.R.)
| | - Ewa Rutkowska
- Department of Clinical Oncology, Holy Cross Cancer Center, 25-734 Kielce, Poland; (R.D.); (E.R.)
| | - Łukasz Galus
- Department of Medical and Experimental Oncology, University of Medical Sciences, 61-701 Poznan, Poland; (Ł.G.); (J.M.)
| | - Natasza Kempa-Kamińska
- Department of Clinical Oncology, Wroclaw Comprehensive Cancer Center, 53-413 Wroclaw, Poland; (N.K.-K.); (J.C.)
| | - Jacek Calik
- Department of Clinical Oncology, Wroclaw Comprehensive Cancer Center, 53-413 Wroclaw, Poland; (N.K.-K.); (J.C.)
| | - Agata Sałek-Zań
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Kraków, Poland; (B.C.-S.); (K.P.); (A.S.-Z.); (T.Z.)
| | - Tomasz Zemełka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Kraków, Poland; (B.C.-S.); (K.P.); (A.S.-Z.); (T.Z.)
| | - Wiesław Bal
- Department of Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | | | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melansoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.R.); (K.O.); (T.Ś.); (P.R.)
| | - Grażyna Kamińska-Winciorek
- The Skin Cancer and Melanoma Team, Department of Bone Marrow Transplantation and Hematology-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Rafał Suwiński
- II Clinic of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Jacek Mackiewicz
- Department of Medical and Experimental Oncology, University of Medical Sciences, 61-701 Poznan, Poland; (Ł.G.); (J.M.)
- Department of Diagnostics and Cancer Immunology, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melansoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.R.); (K.O.); (T.Ś.); (P.R.)
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Aglietta M, Chiarion-Sileni V, Fava P, Guidoboni M, Depenni R, Minisini A, Consoli F, Ascierto P, Rinaldi G, Banzi M, Marconcini R, Gueli R, Ferraresi V, Tucci M, Tonini G, Lo Re G, Guida M, Del Vecchio M, Marcon IG, Queirolo P. Retrospective Chart Review of Dabrafenib Plus Trametinib in Patients with Metastatic BRAF V600-Mutant Melanoma Treated in the Individual Patient Program (DESCRIBE Italy). Target Oncol 2021; 16:789-799. [PMID: 34755244 PMCID: PMC8613139 DOI: 10.1007/s11523-021-00850-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Real-world data on extended follow-up of patients with BRAF V600-mutant metastatic melanoma are limited. We investigated dabrafenib plus trametinib (dab + tram) outside of a clinical trial setting (Individual Patient Program; DESCRIBE Italy). OBJECTIVE To describe the baseline features, treatment patterns, efficacy, and safety outcomes in patients with BRAF V600-mutant unresectable or metastatic melanoma who had received dab + tram as part of the Managed Access Program (MAP) in Italy. PATIENTS AND METHODS An observational, retrospective chart review was conducted in Italian patients with BRAF V600-mutant unresectable stage III/IV melanoma receiving dab + tram as part of the MAP. Baseline features, treatment patterns, efficacy, and safety outcomes were evaluated. RESULTS Overall, 499 patients were included in this analysis. BRAF V600E mutation was seen in 81.4% of patients. Overall response rate achieved in 243 of the 390 evaluable patients was 62.3% (95% CI 57.5-67.1). Median progression-free survival (PFS) was 9.3 months (95% CI 8.6-10.6). Subgroup analyses revealed that patients with normal lactate dehydrogenase (LDH) and ≤ three metastatic sites without brain metastases at baseline had better outcomes. With normal LDH at baseline, median PFS for patients with one or two metastatic sites other than cerebral was 18 months. No new safety signals were observed. Treatment was permanently discontinued because of treatment-emergent adverse events (TEAEs) in 9.2% of patients, and pyrexia (27.3%) was the most common TEAE, with a lower incidence than that in the phase 3 studies of dab + tram. CONCLUSION Treatment of BRAF V600E-mutant metastatic melanoma with dab + tram in the real-world setting was effective and safe, including the unselected population with several patients having a high tumor burden - concordant with the results of the pivotal phase 3 studies of dab + tram.
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Affiliation(s)
- Massimo Aglietta
- Department of Oncology, University of Torino, Turin, Italy.
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.
| | - Vanna Chiarion-Sileni
- Department of Clinical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paolo Fava
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Guidoboni
- Immunotherapy-Cell Therapy and Biobank, IRCCS-IRST, Meldola (FC), Italy
| | - Roberta Depenni
- Department of Oncology and Hematology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Minisini
- Department of Oncology, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Paolo Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Maria Banzi
- Oncology Unit, Presidio Ospedaliero Arcispedale Santa Maria Nuova AUSL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Riccardo Marconcini
- Presidio Ospedaliero S. Chiara-Az. Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Rossana Gueli
- Medical Oncology, ASST Sette Laghi, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Tucci
- Department of Biomedical Sciences and Clinical Oncology, University of Bari, "Aldo Moro", Bari, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giovanni Lo Re
- Oncologia Medica e dei Tumori Immunocorrelati, CRO Aviano IRCCS, Aviano, Italy
| | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto dei Tumori "Giovanni Paolo II", Bari, Italy
| | - Michele Del Vecchio
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Paola Queirolo
- Oncology Division, Policlinico San Martino IRCCS, Genoa, Italy
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
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7
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Quaglino P, Fava P, Tonella L, Rubatto M, Ribero S, Fierro MT. Treatment of Advanced Metastatic Melanoma. Dermatol Pract Concept 2021; 11:e2021164S. [PMID: 34447613 DOI: 10.5826/dpc.11s1a164s] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 12/13/2022] Open
Abstract
The introduction in clinical practice of new drug compounds both targeted therapies anti-BRAF and checkpoint inhibitors have largely improved our potential to manage advanced metastatic melanoma patients. This has led to a significant improvement in terms of response rates and particularly in the overall survival (OS). The long-term results of trials with follow-up data of patients treated with targeted or immunotherapies reported median OS rates around 24 months, with 5-year survival rates around 35-40%. As to the drugs currently available and reimbursed by the Italian National Health System, 3 combinations of anti-BRAF/anti-MEK inhibitors are available (dabrafenib/trametinib, vemurafenib/cobimetinib and the most recently introduced encorafenib/binimetinib). As for checkpoint inhibitors, first line immunotherapy is represented by anti-PD1 blockers (nivolumab and pembrolizumab), whilst the anti-CTLA-4 ipilimumab can be used as second line immunotherapy. The decision-making factors that define the best treatment approach in stage IV patients with metastatic melanoma include the mutation pattern, performance status, high/low tumor load, brain metastases, progression pattern (low/fast), and availability of clinical trials. This review will analyze the current therapeutic tools adopted for the treatment of metastatic melanoma patients. It will then focus on the latest results obtained by novel treatments (checkpoint inhibitors and targeted therapies) which can be used in the clinical daily practice.
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Affiliation(s)
- Pietro Quaglino
- Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Paolo Fava
- Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Luca Tonella
- Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Marco Rubatto
- Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Simone Ribero
- Dermatologic Clinic, University of Turin Medical School, Turin, Italy
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