BRAF V600–Mutated Metastatic Melanoma: Factors Affecting Survival
Posted: Thursday, September 27, 2018
Patients with BRAF V600–mutated metastatic melanoma, and their physicians, may be able to use the information presented in an analysis published in JAMA Oncology to help decide among treatment options, including dacarbazine, vemurafenib, or cobimetinib plus vemurafenib. The “key determinants” of survival outcomes identified include baseline lactate dehydrogenase (LDH) level, performance status, disease burden, and gene signature.
“Cobimetinib plus vemurafenib provided survival advantages over vemurafenib monotherapy across all prognostic subgroups,” wrote Axel Hauschild, MD, of the University Hospital Schleswig-Holstein, Kiel, Germany, and colleagues. “The results of this analysis provide a framework that may be used to compare treatment outcomes for patients with metastatic melanoma across trials and regimens.”
Using a retrospective and exploratory recursive partitioning analysis, the team modeled associations between prespecified covariates and survival outcomes in 1,365 patients (57.4%, men; 75.6%, 66 years and older). They used pooled data from the BRIM-2, BRIM-3, BRIM-7, and coBRIM studies.
The median progression-free survival (11.1 months) was longest in patients with lower LDH, an Eastern Cooperative Oncology Group performance status of 0, and shorter baseline sum of the longest diameters of target lesions. The median overall survival (27.2 months) was longest in patients with normal LDH levels and shorter diameters of target lesions. The gene signature was a significant prognostic factor for progression-free survival, although it was not significant for overall survival, in those with normal LDH levels.
“Similar progression-free survival trends were observed when these prognostic subgroups were applied to the cobimetinib plus vemurafenib, vemurafenib alone, and dacarbazine cohorts,” wrote Dr. Hauschild and colleagues.