Activity and safety of third-line BRAF-targeted therapy (TT) following first-line TT and second-line immunotherapy (IT) in advanced melanoma.

Authors

null

Victoria Atkinson

University of Queensland, Brisbane, Australia

Victoria Atkinson , Kathleen Batty , Georgina V. Long , Matteo S. Carlino , Geoffrey David Peters , Prachi Bhave , Maggie A. Moore , Wen Xu , Lauren Julia Brown , Melissa Arneil , Megan Lyle , Alexander M. Menzies

Organizations

University of Queensland, Brisbane, Australia, Melanoma Institute of Australia, Sydney, Australia, Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital, Mater Hospital, Sydney, Australia, Westmead Hospital, Sydney, NSW, Australia, Princess Alexandra Hospital, Brisbane, Australia, Northern Health, Epping, Australia, Alfred Hospital, Brunswick West, Australia, Princess Alexandra Hospital, Moorooka, QLD, Australia, Crown Princess Mary Cancer Care Centre, Westmead, NSW, Australia, Liz Plummer Cancer Centre, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia, Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia

Research Funding

No funding received
None

Background: Patients with advanced melanoma who progress on 1st line TT and 2nd line IT have limited treatment options. We explored the safety and efficacy of re-treatment with 3rd line TT. Methods: was pooled from 6 centers in Australia from 2009-2018. Eligible patients with BRAF V600 mutant melanoma had 1st line therapy with a BRAF/MEK inhibitor, 2nd line IO and were re-challenged with a BRAF/MEK inhibitor. Results: 90 patients were included; median age 61 years, 78% BRAF V600E, 89% ECOG 0-1 at baseline. 1st line TT was combination BRAF/MEK inhibitors in 80%, predominately dabrafenib/trametinib. Response to 1st line therapy was CR 20%, PR 41%, SD 17% and PD 13% and median duration of therapy was 7.2 months (0-33 months). 70% stopped for progressive disease, 9% toxicity and 16% had a planned switch to immunotherapy. For 2nd line IT, 49% had PD-1 alone, 33% had PD-1+CTLA-4, 14% had CTLA-4 alone. Only median duration on IT was 67 days (0-23 months), 81% ceased for PD, 14% for toxicity. Of patients who had a planned switch to IO before 1st line TT progression, one patient responded to second line IO with SD as BORR, there were no other responses to 2nd line IO in the planned switch group. At 3rd line TT re-challenge, 54% were AJCC stage IVd, 34% IVc, 51% had elevated LDH, 59% ECOG 0-1. 47% were re-challenged with dabrafenib/trametinib, 33% vemurafenib/cobimetinib, 11% encorafenib/binimetinib. BORR was 28%, with median duration on 3rd line TT 81 days. The OS was 1.7 years, with 34% alive at time of analysis. Conclusions: Despite progression on 1st line TT and 2nd line IT, patients may experience meaningful response and on re-challenge TT.

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Citation

J Clin Oncol 38: 2020 (suppl; abstr 10049)

DOI

10.1200/JCO.2020.38.15_suppl.10049

Abstract #

10049

Poster Bd #

398

Abstract Disclosures