Combined BRAF and MEK inhibition with PD-1 blockade immunotherapy in BRAF-mutant melanoma

A Ribas, D Lawrence, V Atkinson, S Agarwal… - Nature medicine, 2019 - nature.com
Nature medicine, 2019nature.com
Oncogene-targeted therapy with B-Raf proto-oncogene (BRAF) and mitogen-activated
protein kinase kinase (MEK) inhibitors induces a high initial response rate in patients with
BRAF V600-mutated melanoma, with a median duration of response of approximately 1
year,–. Immunotherapy with antibodies to programmed death 1 (PD-1) produces lower
response rates but with long response duration. Preclinical models suggest that combining
BRAF and MEK inhibitors with PD-1 blockade therapy improves antitumor activity,–, which …
Abstract
Oncogene-targeted therapy with B-Raf proto-oncogene (BRAF) and mitogen-activated protein kinase kinase (MEK) inhibitors induces a high initial response rate in patients with BRAFV600-mutated melanoma, with a median duration of response of approximately 1 year, –. Immunotherapy with antibodies to programmed death 1 (PD-1) produces lower response rates but with long response duration. Preclinical models suggest that combining BRAF and MEK inhibitors with PD-1 blockade therapy improves antitumor activity, –, which may provide additional treatment options for patients unlikely to have long-lasting responses to either mode of therapy alone. We enrolled 15 patients with BRAFV600-mutated metastatic melanoma in a first-in-human clinical trial of dabrafenib, trametinib and pembrolizumab (NCT02130466). Eleven patients (73%) experienced grade 3/4 treatment-related adverse events, the most common being elevation of liver function tests and pyrexia, most of which resolved with drug interruption or discontinuation of either the anti-PD-1 antibody or the targeted therapy combination. Eleven patients (73%; 95% confidence interval = 45–92%) had an objective response, and six (40%; 95% confidence interval = 16–68%) continued with a response at a median follow-up of 27 months (range = 10.3–38.4+ months) for all patients. This study suggests that this triple-combined therapy may benefit a subset of patients with BRAFV600-mutated metastatic melanoma by increasing the frequency of long-lasting antitumor responses.
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