Is the BRAF mutation still an unfavorable risk factor in patients with metastatic melanoma in the era of modern therapies?

Authors

null

Bozena Cybulska-Stopa

Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Cracow, Poland

Bozena Cybulska-Stopa , Anna Malgorzata Czarnecka , Krzysztof Ostaszewski , Karolina Piejko , Marcin Zietek , Robert Dziura , Ewa Rutkowska , Łukasz Galus , Jacek Calik , Agata Sałek-Zań , Tomasz Zemelka , Agnieszka Kamycka , Wieslaw Bal , Tomasz Kubiatowski , Pawel Rogala , Tomasz Switaj , Grazyna Kaminska-Winciorek , Rafał Suwiński , Jacek Mackiewicz , Piotr Rutkowski

Organizations

Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Cracow, Poland, Department of Oncology, Military Institute of Medicine, Warsaw, Poland, Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland, Department of Oncology, Wroclaw Medical University; Department of Surgical Oncology, Wroclaw Comprehensive Cancer Center, Wroclaw, Poland, Clinical Oncology Department, Holy Cross Cancer Center, Kielce, Poland, MARIA SKLODOWSKA CURIE GREATER POLAND CANCER CTR., Poznan, Poland, Department of Clinical Oncology, Wroclaw Comprehensive Cancer Center, Wroclaw, Poland, M Sklodowska Curie Mem Cancer Inst, Krakow, Poland, Podkarpacki Centrum Onkologii w Rzeszowie, Rzeszów, Poland, Gliwice Oncology Institute, Gliwice, Poland, MSWiA Hospital Olsztyn, Olsztyn, Poland, The Department of Bone Marrow Transplantation and Onco-Hematology, Skin Cancer and Melanoma Team, Maria Sklodowska- Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland, II Clinic of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland

Research Funding

No funding received

Background: BRAF-mutated (MUT) melanoma is characterized by specific clinical features including more aggressive biological behavior than BRAF wild-type (WT) melanoma. BRAF mutations are historically known as negative prognostic factor for to shorter overall survival (OS) in patients with stage IV disease with melanoma. Methods: Consecutive patients with unresectable or metastatic melanoma started treatment with BRAF inhibitors (BRAFi), BRAFi and MEK inhibitors (MEKi) or IT (anti-PD-1 antibody) between 1/Jan/2013 and 31/Dec/2020. Clinical factors including age, gender, primary location of melanoma, ECOG performance status, baseline LDH level, and location of metastases, response to treatment were analyzed. Survival analyses were performed using the Kaplan-Meier method, Log-rank and chi-square tests were used for comparison between groups. Data cut-off was 31/Dec/2021. Results: In total 1456 patients were enrolled. BRAF mutation was found in 723 (49.7%) patients and 733 (50.3%) patients were BRAF WT. All BRAF WT patients received first-line IT, while BRAF MUT patient received first-line treatment with BRAFi (n = 134/723, 18%), BRAFi and MEKi (n = 426, 58%) or anty-PD-1 (n = 173, 24%). BRAF MUT patients were significantly younger (median 60 vs 69; p < 0.0001), had worse ECOG (p = 0.0008), elevated LDH (p < 0.0001), had higher number of metastatic sites (p < 0.0001) and brain metastases (p < 0.0001). The estimated median OS (mOS) in BRAF WT group was 17.3 month while in BRAF MUT - 14.8 months (p = 0.33; HR = 0.94, Cl 95% 0.8-1.1). mOS in BRAF MUT group treated with BRAFi was - 10.0, while with BRAFi and MEKi combination - 14.9. BRAF WT and BRAF MUT groups treated with IT did not differ significantly in baseline characteristics. BRAF MUT group treated with IT achieved mOS of 26.2 months, while in BRAF WT 17.3 months. Conclusions: The analysis showed no differences in the median OS between BRAF MUT and BRAF WT patients with unresectable or metastatic melanoma treated with novel therapies (BRAFi-MEKi combination or IT), despite unfavorable prognostic factors in the BRAF MUT group. Moreover mOS was significantly prolonged in the BRAF MUT patients treated with IT.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr e21544)

DOI

10.1200/JCO.2022.40.16_suppl.e21544

Abstract #

e21544

Abstract Disclosures

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