A combination of immunotherapy treatments improves survival and lowers the risk of life-threatening events for patients with late-stage melanoma compared with targeted therapy, according to a new JAMA Oncology report.
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Melanoma, one of the most aggressive forms of skin cancer, accounts for 3.3% of annual new cancer cases and claims a 15% death rate in Canada, where the study was conducted. If diagnosed early, melanoma can be cured with surgery alone. However, patients with melanoma who are diagnosed at later stages cannot be treated with surgery and must rely on drug therapy for treatment. Optimal treatment strategies for these patients have been a source of debate.
Researchers at the McMaster University Michael G. DeGroote School of Medicine, led by Feng Xie, PhD, associate professor in the Department of Clinical Epidemiology and Biostatistics, conducted a systematic review and meta-analysis to compare the efficacy and safety of targeted therapies and immune therapy for advanced BRAF-mutated melanoma. The study included randomized controlled trials of targeted therapy with BRAF/MEK inhibitors or immune therapy with PD-1 or CTLA-4 checkpoint inhibitors in a total of 6662 patients between 2011 and 2015. The patients had been diagnosed with advanced BRAF-mutated melanoma but had yet to receive any treatment before the systemic therapies.
The result of the study showed that treatment with a combination of BRAF- and MEK-targeted therapy and treatment with PD-1 immunotherapy were equally effective in improving survival rates. However, whereas combined BRAF and MEK inhibition proved to be most effective in improving progression-free survival, PD-1 inhibition provided the lowest risk of life-threatening events. Therefore, the authors concluded that PD-1 immunotherapy is the recommended first-line therapy option due to its superior safety profile.
"This is the first analysis to draw comparison between targeted and immune therapies for BRAF-mutated melanomas," Dr Xie explained in a press release. "Our results will help patients and clinicians choose treatments."
