Real-world outcomes of different lines and sequences of treatment in BRAF-positive advanced melanoma patients Journal Article


Authors: Betof Warner, A.; Tarhini, A.; Kang, B.; Nakasato, A.; Ling, Y. L.; Shah, R.; Tang, J.; Patel, J.
Article Title: Real-world outcomes of different lines and sequences of treatment in BRAF-positive advanced melanoma patients
Abstract: The objective of this study is to compare efficacy with different treatment sequences and lines of treatment among BRAF V600 mutated (BRAF+) advanced melanoma patients with immunotherapies (IO) and targeted therapies (TT) using real-world data. This was a retrospective cohort study using the Novartis BRAF+ meLanoma patients ObsErvational database, the harmonized customized data from Flatiron and ConcertAI. The study included BRAF+ advanced unresectable melanoma patients treated with first-line (1L) IO or TT between 1 January 2014 and 31 May 2020. Patient characteristics and treatment patterns were described. Kaplan-Meier curves and propensity score-adjusted Cox models were used for analyzing progression-free survival (PFS) and overall survival (OS). A total of 1961 patients were included, of which, 57.2% received IO and 42.8% received TT on 1L therapy. Overall, 603 patients initiated a 2L therapy: 56.2% IO and 43.8% TT. Regardless of treatment sequence, patients progressed at a relatively similar rate with no significant difference between groups (median PFS: 12.9 months for 1L TT/2L IO and 13.1 months for 1L IO/2L TT; HR, 0.84; P = 0.137). The 2-year OS rate was also similar with 1L TT/2L IO and 1L IO/2L TT (78% vs. 80%; HR, 1.09; P = 0.730). PFS was worse on 2L therapy compared with 1L (median 4.7 vs. 6.5 months). Efficacy on 2L therapy was poor compared with 1L. Among patients who received 2L therapy, regardless of treatment sequences, outcomes were comparable between 1L TT/2L IO and 1L IO/2L TT in this study that reflects real-world experiences beyond clinical trial selective eligibility criteria. © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Keywords: adult; cancer survival; controlled study; treatment outcome; middle aged; retrospective studies; major clinical study; overall survival; genetics; clinical feature; advanced cancer; drug withdrawal; patient selection; systemic therapy; treatment duration; cancer patient; ipilimumab; cancer immunotherapy; melanoma; progression free survival; skin neoplasms; cohort analysis; data base; retrospective study; skin tumor; immunotherapy; targeted therapy; observational study; toxicity; b raf kinase; disease exacerbation; braf; proto-oncogene proteins b-raf; braf protein, human; molecularly targeted therapy; comparative effectiveness; clinical outcome; advanced melanoma; vemurafenib; dabrafenib; trametinib; treatment patterns; nivolumab; disease burden; humans; human; male; female; article; binimetinib; pembrolizumab; encorafenib; cobimetinib; ecog performance status; real-world outcomes; treatment sequence
Journal Title: Melanoma Research
Volume: 33
Issue: 1
ISSN: 0960-8931
Publisher: Lippincott Williams & Wilkins  
Date Published: 2023-02-01
Start Page: 38
End Page: 49
Language: English
DOI: 10.1097/cmr.0000000000000856
PUBMED: 36545921
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 February 2023 -- Source: Scopus
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