Thursday, August 13, 2015

Being female with low LDH, no ulceration in primary, and BRAF V600E positive = increased rates of survival with BRAFi for melanoma patients?!!!

Clinicicopathologic features associated with efficacy and long-term survival in metastatic melanoma patients treated with BRAF or combined BRAF and MEK inhibitors.  Menzies, Wilmott, Drummond, et al.  Cancer.  Jul 28, 2015.

For 142 consecutive immunotherapy - and MAPK inhibitor-naive patients with BRAF-mutant metastatic melanoma who were treated during clinical trials with BRAFi (n=111) or the combo of dabrafenib and trametinib (n=31), clinicopathologic factors were correlated with the response to MAPK inhibitors and survival.

Median f/u = 15.7 months.  The 2, 3, and 4 year overall survival (OS) rates were 43%, 24% and 24% respectively.  Statistical analysis demonstrated that the only clinicopathologic factors associated with longer Progression Free Survival (PFS) and OS were being female and a normal pretreatment serum lactate dehydrogenase (LDH) level.  BRAF V600E genotype and an absence of primary melanoma ulceration were also independently associated with longer PFS but not with OS.  The median OS was 23.5 months for patients with normal LDH levels and 7.3 months for those with elevated LDH levels.  Complete responders had the best survival, but disease progression still occurred in 2 of 7 patients.

We certainly need to figure out what treatment works for whom.  I think it is important to note that these patients were all treatment naive...apparently.  For whatever that is worth.  This provides the first real confirmation of the importance of a low LDH to outcome that I have seen.  It also provides one more bad mark for ulceration of primary lesion, as that has long been noted to be related to a poorer prognosis.  

Hang in there, peeps! - c

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