Division of Cancer Services, Gallipoli Medical Research Foundation, The University of Queensland and Princess Alexandra Hospital, Brisbane, QLD.
Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Melanoma Res. 2020 Jun;30(3):261-267. doi: 10.1097/CMR.0000000000000654.
In clinical trials, dabrafenib plus trametinib improved overall survival (OS) compared with single-agent BRAF inhibitors (BRAFi) in patients with BRAF V600-mutant unresectable or metastatic melanoma. We investigated dabrafenib plus trametinib therapy in a compassionate-use setting [Named Patient Program (NPP); DESCRIBE II]. A retrospective chart review of patients with BRAF V600-mutated unresectable stage III/IV melanoma receiving dabrafenib plus trametinib as compassionate use was conducted. Treatment patterns and duration, clinical outcomes, and tolerability were evaluated. Of 271 patients, 92.6% had stage IV melanoma, including 36.5% with brain metastases. Overall, 162 patients (59.8%) were BRAFi naive and 171 (63.1%) received first-line dabrafenib plus trametinib. Among BRAFi-naive patients, the overall response rate (ORR) was 67.3%, median OS (mOS) was 20.0 months, and median progression-free survival (mPFS) was 7.5 months. In BRAFi-naive patients with known brain metastases (n = 62), ORR was 61.3%, mOS was 15.5 months, and mPFS was 6.2 months. Eighty-four patients received BRAFi monotherapy for >30 days and switched to dabrafenib plus trametinib prior to progression. Of these 84 patients, 63 had known disease status at the time of switch, and 22 improved with the combination therapy. No new safety signals were identified, and dabrafenib plus trametinib was well tolerated. Dabrafenib plus trametinib showed substantial clinical activity in NPP patients with BRAF V600-mutated unresectable or metastatic melanoma. Analysis of treatment patterns demonstrated the effectiveness of the combination in patients with brain metastases and across lines of therapy with a well tolerated and manageable safety profile.
在临床试验中,与单药 BRAF 抑制剂(BRAFi)相比,达拉非尼联合曲美替尼可改善 BRAF V600 突变不可切除或转移性黑色素瘤患者的总生存期(OS)。我们在同情用药背景下[命名患者计划(NPP);DESCRIBE II]研究了达拉非尼联合曲美替尼治疗。对接受达拉非尼联合曲美替尼作为同情用药的 BRAF V600 突变不可切除的 III/IV 期黑色素瘤患者进行了回顾性图表审查。评估了治疗模式和持续时间、临床结果和耐受性。在 271 名患者中,92.6%的患者患有 IV 期黑色素瘤,包括 36.5%的患者有脑转移。总体而言,162 名患者(59.8%)为 BRAFi 初治患者,171 名患者(63.1%)接受一线达拉非尼联合曲美替尼治疗。在 BRAFi 初治患者中,总缓解率(ORR)为 67.3%,中位总生存期(mOS)为 20.0 个月,中位无进展生存期(mPFS)为 7.5 个月。在已知有脑转移的 BRAFi 初治患者(n=62)中,ORR 为 61.3%,mOS 为 15.5 个月,mPFS 为 6.2 个月。84 名患者接受 BRAFi 单药治疗>30 天,在疾病进展前转为达拉非尼联合曲美替尼治疗。在这 84 名患者中,63 名患者在转换时已知疾病状态,其中 22 名患者对联合治疗有反应。未发现新的安全性信号,且达拉非尼联合曲美替尼耐受良好。达拉非尼联合曲美替尼在 NPP 患者中显示出显著的临床活性,这些患者患有 BRAF V600 突变不可切除或转移性黑色素瘤。治疗模式分析表明,该联合疗法对脑转移患者以及多线治疗均有效,具有可耐受且可管理的安全性。