Abstract 68P
Background
The management of metastatic melanoma (MM) with BRAF mutations using dabrafenib + trametinib presents a complex landscape. This study investigates real-world clinical and treatment-related outcomes within distinct subgroups of patients with BRAF-positive MM undergoing this specific therapeutic combination in Turkey.
Methods
We retrospectively analyzed the clinical and treatment-related characteristics of patients treated for BRAF mutant MM across 24 centers between 2015 and 2023. Our focus was on exploring nuances in treatment sequences, progression-free survival (PFS), overall survival (OS), and identifying factors influencing survival.
Results
A total of 228 patients were included (mean age: 55±13 years; 14% aged over 70). V600E mutation was present in 85.8%, while 13.8% had V600K mutation. Dabrafenib-trametinib was administered as 1st-line treatment in 80% of cases, and 14.5% received 2nd-line treatment and beyond. The median follow-up was 36 months. Median OS was 23 months, with a 5-year survival rate of 21%. 50% of patients had 3 or more metastatic sites, 25.9% had brain metastases and 32.7% had LDH levels above normal. In the Cox regression model, brain metastasis (HR:2.01, CI:1.29-3.13, p=0.002) and elevated LDH levels (HR:1.63 CI:1.05-2.54, p=0.029) were found as independent factors affecting overall survival. De novo metastasis, mutation type, age, gender, and treatment sequence had no significant impact on overall survival. Forty-five percent of patients received 2nd-line treatment, while only 14% could proceed to 3rd-line treatment. Patients with brain metastases had a mOS of 11 months and those without brain metastases had a mOS of 30 months (p=0.000). The rate of these patients reaching 2nd-line treatment was similar to the all cohort.
Conclusions
IO-IO therapy has also become a priority in BRAF mutant MM patients, especially in situations associated with an aggressive course. However, in middle- and low-income countries, access to these combination regimens is not feasible. The difficulty in accessing such combination therapies underscores the importance of real-world data in guiding patient management decisions.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Turkish Oncology Group.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.