MAPKinase inhibition after failure of immune checkpoint blockade in patients with advanced melanoma - An evaluation of the multicenter prospective skin cancer registry ADOREG.

Abstract

OBJECTIVES:

Forty to sixty percent of patients with advanced melanoma show primary resistance to PD-1-based immunotherapy, 30-40% of initial responders also progress. Here, we evaluated the outcome of second-line targeted therapy (TT) after progression on PD-1-based immune checkpoint inhibition (ICI) in BRAFV600-mutated melanoma. In addition, we report data on the activity of re-exposure with PD-1-based regimes.

METHODS:

Patients with advanced (non-resectable stage III or IV, AJCC 2017, 8th edition) melanoma progressing on PD-1-based ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line BRAF plus MEK inhibition were identified from the prospective multicenter skin cancer registry ADOREG.

RESULTS:

We identified 108 patients with unresectable stage III or stage IV melanoma progressing on first-line ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line combined BRAF/MEK inhibition. Seventy-three percent of the cohort presented with primary PD-1 resistant disease. Median progression-free survival (PFS) on ICI was 2.6 (95% CI 2.2-2.9) months. Median PFS on subsequent TT was 6.6 (95% CI 5.4-7.8) months. Median OS from start of second-line TT was 16.0 (95% CI 11.2-20.8) months. The 3-year PFS and OS rates on second-line TT were 16% and 30%. The objective response rate (ORR) and disease control rate (DCR) to TT were 42.6% and 55.6%. In patients with brain metastases, the ORR and DCR were 31.4% and 43.1%. Patients without brain metastases showed an ORR and DCR of 52.6% and 66.7%, respectively. Response to first-line ICI was associated with a numerically higher ORR and DCR to second-line TT and improved OS on TT. Twenty-three patients received third-line ICI of whom two patients showed an objective response.

CONCLUSIONS:

BRAF plus MEK inhibition shows meaningful activity and outcome in patients with advanced melanoma resistant to anti-PD-1-based immunotherapy. Rates of long-term benefit and survival in our study were similar to those reported for treatment-naïve patients receiving first-line MAPKi.

• Authors: Sophia Kreft, Valerie Glutsch, Anne Zaremba, Patrick Schummer, Peter Mohr, Imke Grimmelmann, Ralf Gutzmer, Friedegund Meier, Claudia Pföhler, Michael Max Sachse, Frank Meiss, Andrea Forschner, Sebastian Haferkamp, Julia Welzel, Patrick Terheyden, Rudolf Herbst, Jochen Utikal, Martin Kaatz, Carsten Weishaupt, Alexander Kreuter, Dirk Debus, Pia Duecker, Anca Sindrilaru, Harald Löffler, Gaston Schley, Michael Weichenthal, Dirk Schadendorf, Selma Ugurel, Anja Gesierich, Bastian Schilling
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 167 Pg. 32-41 (05 2022) ISSN: 1879-0852 [Electronic] England
• PMID: 35366571 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Immune Checkpoint Inhibitors
• Ipilimumab
• Programmed Cell Death 1 Receptor
• Nivolumab
• Proto-Oncogene Proteins B-raf
• Mitogen-Activated Protein Kinase Kinases

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Brain Neoplasms (etiology)
• Humans
• Immune Checkpoint Inhibitors
• Ipilimumab (therapeutic use)
• Melanoma (pathology)
• Mitogen-Activated Protein Kinase Kinases
• Nivolumab (therapeutic use)
• Programmed Cell Death 1 Receptor
• Prospective Studies
• Proto-Oncogene Proteins B-raf (genetics)
• Registries
• Retrospective Studies
• Skin Neoplasms (etiology)