Improved Overall Survival in Melanoma with Combined Dabrafenib and Trametinib

TLDR

BRAF inhibitors such as vemurafenib and dabrafenib have shown efficacy as monotherapies in patients with untreated metastatic melanoma harboring BRAF V600E or V600K mutations. This phase‑3 trial aimed to compare the efficacy of dabrafenib plus trametinib versus vemurafenib as first‑line therapy in metastatic melanoma with BRAF V600 mutations. A total of 704 patients were randomized in an open‑label design to receive either dabrafenib (150 mg BID) with trametinib (2 mg QD) or vemurafenib (960 mg BID). The combination improved overall survival (12‑month OS 72% vs 65%, HR 0.69, P = 0.005), progression‑free survival (11.4 vs 7.3 months, HR 0.56, P < 0.001), and objective response rate (64% vs 51%, P < 0.001), with similar toxicity and a lower incidence of cutaneous squamous‑cell carcinoma (1% vs 18%). The study was funded by GlaxoSmithKline and registered under ClinicalTrials.gov NCT01597908.

Abstract

The BRAF inhibitors vemurafenib and dabrafenib have shown efficacy as monotherapies in patients with previously untreated metastatic melanoma with BRAF V600E or V600K mutations. Combining dabrafenib and the MEK inhibitor trametinib, as compared with dabrafenib alone, enhanced antitumor activity in this population of patients.In this open-label, phase 3 trial, we randomly assigned 704 patients with metastatic melanoma with a BRAF V600 mutation to receive either a combination of dabrafenib (150 mg twice daily) and trametinib (2 mg once daily) or vemurafenib (960 mg twice daily) orally as first-line therapy. The primary end point was overall survival.At the preplanned interim overall survival analysis, which was performed after 77% of the total number of expected events occurred, the overall survival rate at 12 months was 72% (95% confidence interval [CI], 67 to 77) in the combination-therapy group and 65% (95% CI, 59 to 70) in the vemurafenib group (hazard ratio for death in the combination-therapy group, 0.69; 95% CI, 0.53 to 0.89; P=0.005). The prespecified interim stopping boundary was crossed, and the study was stopped for efficacy in July 2014. Median progression-free survival was 11.4 months in the combination-therapy group and 7.3 months in the vemurafenib group (hazard ratio, 0.56; 95% CI, 0.46 to 0.69; P<0.001). The objective response rate was 64% in the combination-therapy group and 51% in the vemurafenib group (P<0.001). Rates of severe adverse events and study-drug discontinuations were similar in the two groups. Cutaneous squamous-cell carcinoma and keratoacanthoma occurred in 1% of patients in the combination-therapy group and 18% of those in the vemurafenib group.Dabrafenib plus trametinib, as compared with vemurafenib monotherapy, significantly improved overall survival in previously untreated patients with metastatic melanoma with BRAF V600E or V600K mutations, without increased overall toxicity. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT01597908.).