82P - A clinical insight into therapeutic sequence in advanced melanoma (82P)

Date 08 December 2017
Event ESMO Immuno-Oncology Congress 2017
Session Lunch & Poster Display session
Topics Cancer Immunology and Immunotherapy
Translational Research
Presenter Jesus Vera-Aguilera
Citation Annals of Oncology (2017) 28 (suppl_11): xi6-xi29. 10.1093/annonc/mdx711
Authors J. Vera-Aguilera, J. Paludo, N. Duma, M. Tschautscher, S. Markovic
  • Hematology And Oncology, Mayo Clinic, 55905 - Rochester/US

Abstract

Background

The optimal sequence strategy of BRAF/MEK inhibitors, anti-PD-1/PDL-1 and anti-CTLA-4 in metastatic BRAF-mutated melanoma patients (pts) is unknown and no treatment guidelines exist. Therefore, we report a single-institution experience of different treatment approaches using targeted therapy (TT) and immunotherapy and its impact on outcomes.

Methods

BRAF-mutated metastatic melanoma pts treated with TT and immunotherapy from 2012 to2017 were analyzed. Six groups were identified based on treatment strategy. All time-to-event analyses were calculated using the Kaplan-Meier method and Wilcoxon test.Table: 82P Treatment characteristics by group

Median duration of therapy in weeks
Group (n)1st line therapy (median)2nd line therapy (median)3rd line therapy (median)Total median (range)Chemotherapy (n)
1 (9)TT (17)Immunotherapy (14)N/A52 (13-134)5
1.1 (7)TT (25)Triple therapy (19)Any* (43)69 (22-118)1
1.2 (2)TT (60)Immunotherapy (16)Triple therapy (21)96 (81-111)1
2 (18)Immunotherapy (11)TT (19)Any* (24)48 (16-120)5
2.1 (4)Immunotherapy (17)Triple therapy (16)Any* (9)41 (25-69)0
2.2 (4)Immunotherapy (19)TT (16)Triple therapy (19)61 (54-73)1
*

any regimen such as checkpoint inhibitors, TT or chemotherapy

Results

Forty-four pts were identified. The median age at diagnosis was 49 years (range 21-73), 54% pts were females and 43% developed brain metastases during disease course. The most common approach strategy was immunotherapy followed by TT, the median duration of treatment was 11 and 19 weeks, respectively. Time-to-next therapy (TTNT) following 1st line treatment was similar in pts treated with TT (median 23 weeks [95% CI: 15-31]) or immunotherapy (median 26 weeks [95% CI: 10-33], p = 0.94). A trend towards better overall survival (OS) was seen in pts who received immunotherapy followed by TT (p = 0.09); patients who received salvage chemotherapy (carboplatin/paclitaxel) had significantly longer OS (median 7 years [95% CI: 3.2-7.08]) (p = 0.03).

Conclusions

No differences in TTNT were seen with immunotherapy, TT or combined (triple therapy) when used as 1st or 2nd line. The significant longer OS benefit with 1st line immunotherapy was only seen in patients who received chemotherapy later in their treatment course.

Clinical trial identification

Legal entity responsible for the study

Mayo Clinic

Funding

None

Disclosure

All authors have declared no conflicts of interest.