Treatment Sequencing and Clinical Outcomes in BRAF-Positive and BRAF-Negative Unresectable and Metastatic Melanoma Patients Treated with New Systemic Therapies in Routine Practice
| العنوان: | Treatment Sequencing and Clinical Outcomes in BRAF-Positive and BRAF-Negative Unresectable and Metastatic Melanoma Patients Treated with New Systemic Therapies in Routine Practice |
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| المؤلفون: | Tomasz Switaj, Paweł Rogala, Iwona Lugowska, Piotr Rutkowski, Anna M. Czarnecka, Anna Mariuk-Jarema, Monika Dudzisz-Sledz, Paweł Teterycz |
| المصدر: | Targeted Oncology. 14:729-742 |
| بيانات النشر: | Springer Science and Business Media LLC, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, Proto-Oncogene Proteins B-raf, 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, Skin Neoplasms, medicine.medical_treatment, Programmed Cell Death 1 Receptor, Disease-Free Survival, Targeted therapy, 03 medical and health sciences, Antineoplastic Agents, Immunological, 0302 clinical medicine, Internal medicine, medicine, Humans, Pharmacology (medical), Neoplasm Metastasis, Practice Patterns, Physicians', Neutrophil to lymphocyte ratio, Melanoma, Protein Kinase Inhibitors, neoplasms, Survival rate, Retrospective Studies, Proportional hazards model, business.industry, Retrospective cohort study, Immunotherapy, Middle Aged, MAP Kinase Kinase Kinases, medicine.disease, digestive system diseases, Survival Rate, 030104 developmental biology, 030220 oncology & carcinogenesis, Mutation, Cohort, Female, business |
| الوصف: | Although BRAF/MEK inhibitors are generally considered to be equally effective whether given before or after immunotherapy, no prospective trial has confirmed this hypothesis and contradictory data have been published in the melanoma field. We aimed to investigate the outcomes of patients with metastatic melanoma depending on the first-line treatment. In this ambidirectional cohort, single-center study, we included 253 consecutive melanoma patients treated in our institution with an anti-PD1 antibody or BRAF/MEK inhibitors, who started first-line treatment between December 2015 and March 2018. Kaplan–Meier estimator, log-rank test, and Cox proportional hazard model were used in this analysis. First-line median progression-free survival (PFS) for all patients was 5.7 months (m), 6.9 m on anti-PD-1 therapy and 5.6 m for combination targeted therapy. Patients with BRAF mutated melanoma had 6.0 m median PFS on immunotherapy. At a median follow-up of 23.2 m with 149 events, in BRAF wild-type patients treated with anti-PD1, median overall survival (OS) was 18.1 m. BRAF mutated patients treated with first-line BRAF/MEK inhibitors had 11.7 m median OS. High neutrophil to lymphocyte ratio, high LDH level, ECOG > 0, and the presence of brain metastases negatively impacted PFS and OS. In BRAF mutated patients with normal LDH, first-line immunotherapy seems a more effective approach. We have demonstrated that although BRAF mutation is a negative prognostic factor in stage IV melanoma, the use of two different systemic treatment modalities allows achievement of comparable survival in BRAF mutated and BRAF wild-type patients. |
| تدمد: | 1776-260X 1776-2596 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fcedb2c1c96b36e4e2d7e14e32966bbaTest https://doi.org/10.1007/s11523-019-00688-8Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....fcedb2c1c96b36e4e2d7e14e32966bba |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1776260X 17762596 |
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