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Advanced melanoma therapy should continue beyond disease progression
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Continued use of vemurafenib, even after disease progression, can improve survival outcomes for patients with BRAF V600-mutated advanced melanoma.
More than half of diagnosed melanomas harbor BRAF V600 mutations, and the introduction of targeted agents such as vemurafenib (Zelboraf, Hoffmann-La Roche) and dabrafenib (Tafinlar, GlaxoSmithKline) triggered a paradigm shift in the treatment of BRAF-mutated melanoma.
However, standard treatment practice is to discontinue use of these targeted agents upon disease progression, not unlike classic regimens such as cytotoxic chemotherapy.
Because BRAF-mutated melanoma progresses rapidly after treatment, John Haanen, PhD, of the division of immunology at Netherlands Cancer Institute, and colleagues conducted a single-institution retrospective study to determine whether continued use of vemurafenib after disease progression could extend OS in patients with BRAF V600-mutated advanced melanoma.
The analysis included 70 patients with metastatic melanoma who demonstrated objective response to treatment with vemurafenib but subsequently experienced progression. Thirty-five patients continued to receive vemurafenib after progression, and 35 patients stopped vemurafenib treatment at disease progression.
Researchers reported significantly longer median OS among patients who continued vemurafenib treatment (5.2 months vs. 1.4 months; P = .002).
Multivariate Cox regression analysis showed stopping vemurafenib treatment at disease progression was associated with significantly shorter survival (HR = 1.92; 95% CI, 1.04-3.55).
These results compared favorably with previous studies, which showed the continued use of targeted immunotherapy after progression improved survival outcomes for patients with other malignancies.
“Our data suggest that BRAF inhibitor treatment beyond progression can benefit melanoma patients who initially responded to treatment,” Haanen and colleagues wrote. “A retrospective subgroup analysis of the global safety study cohort could confirm these results, or at least give us more insight. … In addition, quality of life analyses should be performed. Identification of biomarkers to identify patients [who] benefit from treatment beyond progression could round up such analyses.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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