ESMO Immuno-Oncology 2020: First-Line Anti–PD-1 Therapy vs BRAF/MEK Inhibition for Advanced BRAF V600–Mutated Melanoma

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Findings from a propensity-matched survival analysis presented by van Breeschoten et al at the European Society for Medical Oncology (ESMO) Immuno-Oncology Virtual Congress 2020 (Abstract 37P) suggest that patients with advanced melanoma and a BRAF V600 mutation derive an enhanced survival benefit from first-line treatment with anti–PD-1 monotherapy vs BRAF/MEK inhibitors.

Researchers explained that currently, data are inconclusive on whether to use anti–PD-1 monotherapy or BRAF/MEK inhibitors as first-line treatment in patients with advanced BRAF V600–mutant melanoma, prompting this propensity score-matching study, which compared the two types of agents in this patient population.  


The investigators identified patients diagnosed with unresectable stage III or IV melanoma who had a known BRAF V600 mutation and were registered in the Dutch Melanoma Treatment Registry. From 2014 to 2017, a total of 254 of these patients received first-line treatment with anti–PD-1 monotherapy and 330 received first-line treatment with BRAF/MEK inhibitors. Of these, 310 patients were matched based on their propensity scores using the nearest neighbor and the optimal matching method for inclusion in the matched cohort.

Comparison of Regimens

Comparison of these two first-line treatment strategies in the matched cohort showed that patients receiving anti–PD-1 antibodies demonstrated a higher median and 12-month overall survival compared to patients treated with first-line BRAF/MEK inhibitors.  

Median overall survival was 42.3 months (95% confidence interval [CI] = 37.3 months–not estimable) with anti–PD-1 monotherapy compared to 19.8 months (95% CI = 16.7 months–24.3 months) with BRAF/MEK inhibitors in the matched cohort. The 24-month overall survival rates were 64.0% (95% CI = 58.2%–70.4%) compared to 41.7% (95% CI = 34.2%–51.0%).

The authors concluded that these data suggest that anti–PD-1 monotherapy is the preferred first-line treatment in matched patients with BRAF V600–mutant advanced melanoma and relatively favorable patient and tumor characteristics, and added that they await results from currently ongoing randomized clinical studies to confirm this finding.

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