Abstract

Aim: To evaluate optimal systemic therapy sequencing (first-line targeted therapy (1L-TT) vs. first-line immunotherapy (1L-IO)) in patients with BRAF-mutated metastatic melanoma. Methods: Nation-wide prospective data of patients with newly diagnosed BRAF-mutated metastatic melanoma were retrieved from the Canadian Melanoma Research Network. Results: Our study included 79 and 107 patients in the 1L-IO and 1L-TT groups, respectively. There were more patients with ECOG 0–1 (91% vs. 72%, p = 0.023) in the 1L-IO group compared to the 1L-TT group. Multivariable Cox analysis suggested no OS differences between the two groups (HR 0.838, 95%CI 0.502–1.400, p = 0.500). However, patients who received 1L-TT then 2L-IO had the longest OS compared to 1L-IO without 2L therapy, 1L-IO then 2L-TT, and 1L-TT without 2L therapy (38.3 vs. 32.2 vs. 16.9 vs. 6.3 months, p < 0.001). For patients who received 2L therapy, those who received 2L-IO had a trend towards OS improvement compared with the 2L-TT group (21.7 vs. 8.9 months, p = 0.053). Conclusions: Our nation-wide prospective study failed to establish any optimal systemic therapy sequencing in advanced BRAF-mutant melanoma patients. Nevertheless, we provided evidence that immunotherapy has durable efficacy in advanced BRAF-mutant melanoma patients, regardless of treatment line, and that Canadian medical oncologists were selecting the appropriate treatment sequences in a real-world setting, based on patients’ clinical and tumour characteristics.

Highlights

  • Seventy-nine patients were in the 1L-IO group, and 107 patients were in the 1L-TT group

  • There were no other imbalances between the two groups in terms of age (p = 0.374), gender (p = 0.530), lactate dehydrogenase (LDH) (p = 0.739), cancer stage (p = 1.000), number of metastatic sites (p = 0.184), baseline brain metastasis (p = 0.397), BRAF-mutation subtypes (p = 0.326), received palliative radiation therapy (RT) (p = 1.000), or received palliative surgery (p = 0.532)

  • ECOG ≥ 2 (HR 3.957, 95%confidence interval (CI) 2.226–7.034, p < 0.001) were significantly associated with worse overall survival (OS) in BRAF-mutant melanoma patients (Table 3)

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Summary

Objectives

To evaluate optimal systemic therapy sequencing (first-line targeted therapy (1LTT) vs first-line immunotherapy (1L-IO)) in patients with BRAF-mutated metastatic melanoma

Methods
Results
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