Christian Blank, MD, Group Leader of Immunology at the Netherlands Cancer Institute, Amsterdam, formally discussed the COMBI-v findings. He first credited targeted therapy and immunotherapy for almost tripling the chance of patients with metastatic melanoma living beyond 1 year; however, he noted that 80% of patients still do not achieve long-term survival.

COMBI-v and COMBI-d have confirmed the advantage of inhibiting both BRAF and MEK, since monotherapy with a BRAF inhibitor alone affords little that chemotherapy cannot provide, he said.

Although the data are still not mature enough “to draw high-end conclusions,” he said, “they suggest we can achieve real benefit beyond 1.5 years, and as expected, the combination of BRAF and MEK inhibition is superior to BRAF inhibition only…. We now have several trials supporting the superiority of the combination.”

Regarding the LDH subgroup analysis, Dr. Blank found the results somewhat surprising and disappointing but maintained these patients should still be offered the targeted combination. “LDH is a marker for outcome upon targeted therapy, but to a lesser extent than with immunotherapy,” he observed.

“What worries me is that only 47% of patients treated with the combination in COMBI-v got subsequent treatment,” he continued. “Now, with the array of treatment options, we should offer our patients at least two treatment options: one a targeted treatment and one an immunotherapy. When patients do not receive at least a second chance—that is a bad result.”   ■

Disclosure: Dr. Blank reported financial relationships with Bristol-Myers Squibb, Merck, Novartis, Roche, GlaxoSmithKline, and Pfizer.