TY - JOUR
T1 - Adjuvant BRAF-MEK Inhibitors versus Anti PD-1 Therapy in Stage III Melanoma
T2 - A Propensity-Matched Outcome Analysis
AU - De Meza, Melissa M
AU - Blokx, Willeke A M
AU - Bonenkamp, Johannes J
AU - Blank, Christian U
AU - Aarts, Maureen J B
AU - van den Berkmortel, Franchette W P J
AU - Boers-Sonderen, Marye J
AU - De Groot, Jan Willem B
AU - Haanen, John B A G
AU - Hospers, Geke A P
AU - Kapiteijn, Ellen
AU - Van Not, Olivier J
AU - Piersma, Djura
AU - Van Rijn, Rozemarijn S
AU - Stevense-den Boer, Marion
AU - Van der Veldt, Astrid A M
AU - Vreugdenhil, Gerard
AU - Van den Eertwegh, Alfonsus J M
AU - Suijkerbuijk, Karijn P M
AU - Wouters, Michel W J M
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/1/7
Y1 - 2023/1/7
N2 - Adjuvant BRAF/MEK- and anti-PD-1 inhibition have significantly improved recurrence-free survival (RFS) compared to placebo in resected stage III BRAF-mutant melanoma. However, data beyond the clinical trial setting are limited. This study describes the toxicity and survival of patients treated with adjuvant BRAF/MEK inhibitors and compares outcomes to adjuvant anti-PD-1. For this study, stage III BRAF V600 mutant cutaneous melanoma patients treated with adjuvant BRAF/MEK-inhibition or anti-PD-1 were identified from the Dutch Melanoma Treatment Registry. BRAF/MEK- and anti-PD-1-treated patients were matched based on propensity scores, and RFS at 12 and 18 months were estimated. Between 1 July 2018 and 31 December 2021, 717 patients were identified. Of these, 114 patients with complete records were treated with BRAF/MEK therapy and 532 with anti-PD-1. Comorbidities (p = 0.04) and geographical region (p < 0.01) were associated with treatment choice. In 45.6% of BRAF/MEK-treated patients, treatment was prematurely discontinued. Grade ≥ 3 toxicity occurred in 11.5% of patients and was the most common cause of early discontinuation (71.1%). At 12 and 18 months, RFS in BRAF/MEK-treated patients was 85% and 70%, compared to 68% and 68% in matched anti-PD-1-treated patients (p = 0.03). In conclusion, comorbidities and geographical region determine the choice of adjuvant treatment in patients with resected stage III BRAF-mutant melanoma. With the currently limited follow-up, BRAF/MEK-treated patients have better RFS at 12 months than matched anti-PD-1-treated patients, but this difference is no longer observed at 18 months. Therefore, longer follow-up data are necessary to estimate long-term effectiveness.
AB - Adjuvant BRAF/MEK- and anti-PD-1 inhibition have significantly improved recurrence-free survival (RFS) compared to placebo in resected stage III BRAF-mutant melanoma. However, data beyond the clinical trial setting are limited. This study describes the toxicity and survival of patients treated with adjuvant BRAF/MEK inhibitors and compares outcomes to adjuvant anti-PD-1. For this study, stage III BRAF V600 mutant cutaneous melanoma patients treated with adjuvant BRAF/MEK-inhibition or anti-PD-1 were identified from the Dutch Melanoma Treatment Registry. BRAF/MEK- and anti-PD-1-treated patients were matched based on propensity scores, and RFS at 12 and 18 months were estimated. Between 1 July 2018 and 31 December 2021, 717 patients were identified. Of these, 114 patients with complete records were treated with BRAF/MEK therapy and 532 with anti-PD-1. Comorbidities (p = 0.04) and geographical region (p < 0.01) were associated with treatment choice. In 45.6% of BRAF/MEK-treated patients, treatment was prematurely discontinued. Grade ≥ 3 toxicity occurred in 11.5% of patients and was the most common cause of early discontinuation (71.1%). At 12 and 18 months, RFS in BRAF/MEK-treated patients was 85% and 70%, compared to 68% and 68% in matched anti-PD-1-treated patients (p = 0.03). In conclusion, comorbidities and geographical region determine the choice of adjuvant treatment in patients with resected stage III BRAF-mutant melanoma. With the currently limited follow-up, BRAF/MEK-treated patients have better RFS at 12 months than matched anti-PD-1-treated patients, but this difference is no longer observed at 18 months. Therefore, longer follow-up data are necessary to estimate long-term effectiveness.
UR - http://www.scopus.com/inward/record.url?scp=85146570418&partnerID=8YFLogxK
U2 - 10.3390/cancers15020409
DO - 10.3390/cancers15020409
M3 - Article
C2 - 36672358
SN - 2072-6694
VL - 15
JO - Cancers
JF - Cancers
IS - 2
M1 - 409
ER -
