Individuals With Advanced Melanoma Benefit From Immunotherapy As First-Line Treatment

More individuals with advanced melanoma survived for 2 years or more when they received a combination of 2 immunotherapy drugs given before a combination of 2 targeted therapies, if needed compared with individuals who started with targeted therapies.

The clinical trial was stopped early because the results became apparent sooner than expected.

“The drug combinations tested in this trial all improve survival compared to prior standards of care, but we now know which combination should be administered first to achieve maximum benefit for the vast majority of our patients,” Michael Atkins, MD, at the Georgetown Lombardi Comprehensive Cancer Center, said in a statement. “This trial should provide clearer guidance to clinicians on when to administer particular treatments.”

The findings from the DREAMseq phase 3 clinical trial showed that the 2-year overall survival rate for individuals who received immunotherapies as the first treatment was 72% compared with 52% for individuals who were treated with targeted therapies first.

Progression-free survival was also trending in favor of those who started on immunotherapies, according to investigators.

Overall response rates were similar for all permutations of drug administration, except for individuals who received targeted therapies first and then got immunotherapy.

“One conundrum in the data showed that some patients don't do well on initial immunotherapy treatments, and for some reason switching to targeted therapies did not help,” Atkins said in the statement. “We are focusing on trying to determine why there was no benefit for this small group of patients.”

The trial started in 2015 and included 265 individuals with metastatic melanoma who were randomly assigned to 2 groups. Each group received 1 drug combination followed by the other if their cancer resisted.

One combination included dabrafenib and trametinib taken in pill form, which worked to target the effects of a mutation in the BRAF gene. Everyone included had a melanoma that contained a BRAF V600 mutation. The 2 drugs inhibit the function of the proteins associated with the BRAFmutation.

The second drug combination used ipilimumab and nivolumab immunotherapies. The combination disables the cancer’s defense mechanisms, unleashing the body’s antitumor immunity.

About 59% of individuals had been part of the trial for 2 years before it concluded early.

The results were presented at the inaugural American Society of Clinical Oncology Virtual Plenary Series.

Reference

Trial stopped early: giving immunotherapy before targeted therapy improves survival in advanced melanoma. EurekAlert. News release. November 15, 2021. Accessed November 16, 2021. https://www.eurekalert.org/news-releases/934765