Combined BRAF and MEK inhibition with PD-1 blockade immunotherapy in BRAF-mutant melanoma
Antoni Ribas, Donald Lawrence, Victoria Atkinson, Sachin Agarwal, Wilson H Miller Jr, Matteo S Carlino, Rosalie Fisher, Georgina V Long, F Stephen Hodi, Jennifer Tsoi, Catherine S Grasso, Bijoyesh Mookerjee, Qing Zhao, Razi Ghori, Blanca Homet Moreno, Nageatte Ibrahim, Omid Hamid, Antoni Ribas, Donald Lawrence, Victoria Atkinson, Sachin Agarwal, Wilson H Miller Jr, Matteo S Carlino, Rosalie Fisher, Georgina V Long, F Stephen Hodi, Jennifer Tsoi, Catherine S Grasso, Bijoyesh Mookerjee, Qing Zhao, Razi Ghori, Blanca Homet Moreno, Nageatte Ibrahim, Omid Hamid
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 year1-3. 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 activity4-6, 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.
Figures
![Extended Data Fig. 1 |. Pharmacokinetic concentration-time…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8562134/bin/nihms-1751954-f0003.jpg)
![Extended Data Fig. 2 |. Dosing of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8562134/bin/nihms-1751954-f0004.jpg)
![Extended Data Fig. 3 |. Kaplan-Meier estimates…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8562134/bin/nihms-1751954-f0005.jpg)
![Fig. 1 |. Antitumor activity of combined…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8562134/bin/nihms-1751954-f0001.jpg)
![Fig. 2 |. Analyses of biopsy specimens…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8562134/bin/nihms-1751954-f0002.jpg)
Source: PubMed