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Orlova KV, Ledin EV, Zhukova NV, Orlova RV, Karabina EV, Volkonskiy MV, Stroyakovskiy DL, Yurchenkov AN, Protsenko SA, Novik AV, Vorotilina LV, Moiseenko FV, Chang VL, Kazmin AI, Tkachenko SA, Gamaunov SV, Naskhletashvili DR, Samoylenko IV, Vikhrova AS, Utyashev IA, Kharkevich GY, Petenko NN, Shubina IZ, Demidov LV. Real-World Experience with Targeted Therapy in BRAF Mutant Advanced Melanoma Patients: Results from a Multicenter Retrospective Observational Study Advanced Melanoma in Russia (Experience) (ADMIRE). Cancers (Basel) 2021; 13:cancers13112529. [PMID: 34064013 PMCID: PMC8196785 DOI: 10.3390/cancers13112529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Advanced melanoma is a highly aggressive disease with a poor prognosis. Recent clinical trials have shown that targeted therapy (TT) and immunotherapy (IT) lead to significant improvements in responses to treatment and the survival of advanced melanoma patients. However, little information is available in the form of real-world data on treatment patterns and clinical outcomes for patients with advanced BRAF V600 mutant melanoma. To approach this issue, we performed a retrospective study that involved 382 patients with advanced BRAF V600 mutant melanoma, who received TT in twelve medical centers. Our objectives were to evaluate clinical outcomes in real-world settings, as well as treatment patterns, adverse events, objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). Considering these parameters, the results demonstrated the effectiveness of combined TT with BRAF plus MEK inhibitors in patients with brain metastases and across all lines of therapy, which was well-tolerated and manageable and showed a high safety profile. Abstract Clinical trials of targeted therapy (TT) and immunotherapy (IT) for highly aggressive advanced melanoma have shown marked improvements in response and survival rates. However, real-world data on treatment patterns and clinical outcomes for patients with advanced BRAF V600 mutant melanoma are ultimately scarce. The study was designed as an observational retrospective chart review study, which included 382 patients with advanced BRAF V600 mutant melanoma, who received TT in a real-world setting and were not involved in clinical trials. The data were collected from twelve medical centers in Russia. The objective response rates (ORRs) to combined BRAFi plus MEKi and to BRAFi mono-therapy were 57.4% and 39.8%, respectively. The median progression-free survival (PFS) and median overall survival (OS) were 9.2 months and 22.6 months, respectively, for the combined first-line therapy; 9.4 months and 16.1 months, respectively, for the combined second-line therapy; and 7.4 months and 17.1 months, respectively, for the combined third- or higher-line therapy. Analysis of treatment patterns demonstrated the effectiveness of the combined TT with BRAF plus MEK inhibitors in patients with brain metastases, rare types of BRAF mutations, and across lines of therapy, as well as a well-tolerated and manageable safety profile.
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Affiliation(s)
- Kristina V. Orlova
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- Correspondence: (K.V.O.); (I.Z.S.)
| | | | - Natalia V. Zhukova
- SBHI of Saint-Petersburg “City Clinical Oncology Dispensary”, 197022 Saint Petersburg, Russia; (N.V.Z.); (R.V.O.)
- St Petersburg University, 199034 Saint Petersburg, Russia
| | - Rashida V. Orlova
- SBHI of Saint-Petersburg “City Clinical Oncology Dispensary”, 197022 Saint Petersburg, Russia; (N.V.Z.); (R.V.O.)
- St Petersburg University, 199034 Saint Petersburg, Russia
| | | | | | - Daniil L. Stroyakovskiy
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- Moscow City Oncology Hospital No. 62, 143423 Moscow, Russia; (M.V.V.); (A.N.Y.)
| | | | - Svetlana A. Protsenko
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- FSBI “N.N. Petrov National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 197758 Saint Petersburg, Russia;
| | - Alexey V. Novik
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- FSBI “N.N. Petrov National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 197758 Saint Petersburg, Russia;
| | | | - Fedor V. Moiseenko
- FSBI “N.N. Petrov National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 197758 Saint Petersburg, Russia;
- SBHI “Saint-Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncological)”, 197758 Saint Petersburg, Russia
| | - Victor L. Chang
- SBHI “Tambov Region Oncology Dispensary”, 392000 Tambov, Russia;
| | - Aleksandr I. Kazmin
- BHI of Voronezh Region “Voronezh Region Clinical Oncology Dispensary”, 394036 Voronezh, Russia;
| | - Svetlana A. Tkachenko
- SBHI of Kaluga Region “Kaluga Region Clinical Oncology Dispensary”, 248007 Kaluga, Russia;
| | - Sergey V. Gamaunov
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- Chuvash Autonomous Institution “Republic Clinical Oncology Dispensary” of Chuvash Republic MoH, 428020 Cheboksary, Russia
| | - David R. Naskhletashvili
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
| | - Igor V. Samoylenko
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
| | - Anastasia S. Vikhrova
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
| | - Igor A. Utyashev
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- Institute of Oncology, Hadassah Medical Moscow, 121205 Moscow, Russia
| | - Galina Yu. Kharkevich
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
| | - Natalia N. Petenko
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
| | - Irina Zh. Shubina
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
- Correspondence: (K.V.O.); (I.Z.S.)
| | - Lev V. Demidov
- FSBI “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia; (D.R.N.); (I.V.S.); (A.S.V.); (G.Y.K.); (N.N.P.); (L.V.D.)
- Association Professional Melanoma Society (MELANOMA.PRO), 119192 Moscow, Russia; (D.L.S.); (S.A.P.); (A.V.N.); (S.V.G.); (I.A.U.)
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Real-world treatment practice in patients with advanced melanoma. Contemp Oncol (Pozn) 2020; 24:118-124. [PMID: 32774137 PMCID: PMC7403768 DOI: 10.5114/wo.2020.97607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction The treatment outcomes of patients with advanced/metastatic melanoma were poor before the use of new therapeutic options. Material and methods A retrospective analysis was conducted among 287 patients with unresectable stage III and stage IV melanoma treated at the Maria Sklodowska-Curie National Research Institute of Oncology Cracow Branch, from 2013 to 2019. All enrolled patients were treated with immunotherapy (IT; consisting of pembrolizumab/nivolumab, or ipilimumab) or target therapy (TT; consisting of vemurafenib ±cobimetinib or dabrafenib ±trametinib) in at least one treatment line. Results mutation was detected in 152 (55%) patients. In general, the majority of patients (92%) were in very good or good condition (Eastern Cooperative Oncology Group [ECOG] 0 or 1). Brain metastasis was detected in 64 (22%) patients. Median OS and PFS in the experimental group from the beginning of the first-line treatment were 14.9 and 6.7 months, respectively. Across the study population, as a first-line treatment patients received IT, TT as well as CHT, and the median OS was 19.2, 12.6 and 15.9 months, respectively. Multivariate analysis confirmed that normal LDH levels, no brain metastases, ECOG 0, and objective response to the treatment were strong predictors of longer OS. For PFS, absence of brain metastases, ECOG 0, and treatment response were found to be predictive factors on multivariate analysis. Conclusions The administration of new therapies for the treatment of patients with advanced/disseminated melanoma significantly prolonged survival in this group of patients. Nevertheless, further studies should be conducted to assess the effectiveness of various sequences of treatment.
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