Thursday, February 22, 2018
Rechallenge with BRAF/MEK combo in melanoma
For BRAF positive melanoma patients, targeted therapy with a BRAF inhibitor combined with a MEK inhibitor can have amazing results in the destruction of melanoma! Response rates are around 70-80%!! While there are a few exceptions, the problem with this targeted therapy is that the benefit often evaporates around 6-9 months, with sinister melanoma developing the ability to work-around the treatment. These peeps then go on to other treatments. Sometimes those work, sometimes they don't. If they don't, will taking BRAF/MEK again work?????
Now, there's this:
Rechallenge with BRAF-directed treatment in metastatic melanoma: A multi-institutional retrospective study. Valpione, Carlino, Mangana, et al. Eur J Cancer. 2018 Jan 19.
In this study, 116 peeps who had taken BRAFi (a BRAF/MEK combo) for an average of 9.4 months stopped taking it for a variety of reasons ~ and had roughly 8 months of: immunotherapy (72%), other treatment (17%) and drug holiday (11%). They were then rechallenged with a BRAF/MEK combo. Response rate for the rechallenge was 43% with 3% attaining a complete response, 39% a partial response and 24% gaining stable disease, although 30% had progressive disease and 4% were apparently lost to follow-up. Of the 83 peeps who stopped BRAFi initially due to disease progression, 31 responded to the rechallenge - 30 with a partial response and 1 with a complete response. Median OS from BRAFi retreatment was 9.8 months and PFS was 5 months.
Given the results of this study, the answer to the initial question I posed, is: YES, a rechallenge with BRAF/MEK can work with a response rate of about 43% generally and 37% in those who progressed on BRAFi the first go round. Response rates are not as high nor as complete as those attained with the initial treatment....but....they are there!!! Repeating treatment with BRAF/MEK is certainly an option in kicking melanoma in the teeth a bit, while seeking more effective, durable treatment.
It's something. Thanks, ratties. - c