82P - A clinical insight into therapeutic sequence in advanced melanoma

Abstract

Background: The optimal sequence strategy of BRAF/MEK inhibitors, anti-PD-1/PDL-1 and anti-CTLA-4 in metastatic BRAF-mutated melanoma patients (pts) is unknown and no treatment guidelines exist. Therefore, we report a single-institution experience of different treatment approaches using targeted therapy (TT) and immunotherapy and its impact on outcomes. Methods: BRAF-mutated metastatic melanoma pts treated with TT and immunotherapy from 2012 to2017 were analyzed. Six groups were identified based on treatment strategy. All time-to-event analyses were calculated using the Kaplan-Meier method and Wilcoxon test. Results: Forty-four pts were identified. The median age at diagnosis was 49 years (range 21-73), 54% pts were females and 43% developed brain metastases during disease course. The most common approach strategy was immunotherapy followed by TT, the median duration of treatment was 11 and 19 weeks, respectively. Time-to-next therapy (TTNT) following 1st line treatment was similar in pts treated with TT (median 23 weeks [95% CI: 15-31]) or immunotherapy (median 26 weeks [95% CI: 10-33], p = 0.94). A trend towards better overall survival (OS) was seen in pts who received immunotherapy followed by TT (p = 0.09); patients who received salvage chemotherapy (carboplatin/paclitaxel) had significantly longer OS (median 7 years [95% CI: 3.2-7.08]) (p = 0.03).Tabled 1Table: 82P Treatment characteristics by groupMedian duration of therapy in weeksGroup (n)1st line therapy (median)2nd line therapy (median)3rd line therapy (median)Total median (range)Chemotherapy (n)1 (9)TT (17)Immunotherapy (14)N/A52 (13-134)51.1 (7)TT (25)Triple therapy (19)Any*any regimen such as checkpoint inhibitors, TT or chemotherapy (43)69 (22-118)11.2 (2)TT (60)Immunotherapy (16)Triple therapy (21)96 (81-111)12 (18)Immunotherapy (11)TT (19)Any*any regimen such as checkpoint inhibitors, TT or chemotherapy (24)48 (16-120)52.1 (4)Immunotherapy (17)Triple therapy (16)Any*any regimen such as checkpoint inhibitors, TT or chemotherapy (9)41 (25-69)02.2 (4)Immunotherapy (19)TT (16)Triple therapy (19)61 (54-73)1* any regimen such as checkpoint inhibitors, TT or chemotherapy Open table in a new tab Conclusions: No differences in TTNT were seen with immunotherapy, TT or combined (triple therapy) when used as 1st or 2nd line. The significant longer OS benefit with 1st line immunotherapy was only seen in patients who received chemotherapy later in their treatment course. Legal entity responsible for the study: Mayo Clinic Funding: None Disclosure: All authors have declared no conflicts of interest.