Expert Point of View: Landscape for Treatment of Metastatic Melanoma Is Expanding

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At an Annual Meeting press conference, ASCO spokesperson Sylvia Adams, MD, said, “BREAK-3 confirms that BRAF targeting is effective in metastatic melanoma. The tumor shrinkage seen with dabrafenib is similar to results observed for the FDA-approved drug vemurafenib, with fewer side effects. We will want to study whether combination therapy with a MEK inhibitor can overcome resistance to BRAF inhibition.”

Formal discussant at the oral presentation of BREAK-3, Michael Atkins, MD, Director of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, DC, commented, “This is a great trial with potentially practice-changing results. Treatment with dabrafenib was well tolerated, and tumor shrinkage was similar to what we see with vemurafenib. Dabrafenib [if approved] will mean competition in the BRAF inhibitor field, and competition is good for patients and physicians.”

Commenting on the METRIC study, Dr. Adams said, “This trial shows that in metastatic melanoma, MEK pathway–targeted therapy is very effective, with good tumor shrinkage and a survival benefit. This study opens the landscape of treatment for BRAF-positive melanoma.”

In 2012, the bar has been raised with data from BRAF inhibitors, Dr. Atkins added. “But metastatic melanoma is still a bad disease. We have postponed but not prevented death from this disease, and much work is needed to raise the bar even higher. Current strategies are being pursued to build on BRAF inhibitor data, such as combining immunotherapy with a BRAF inhibitor, either alone or in combination with a MEK inhibitor. With optimal BRAF inhibition and optimal immune therapy, and maybe with other strategies as well, we can raise the bar further and eliminate death from this disease.” ■

Disclosure: Dr. Adams is a consultant for GlaxoSmithKline Biologicals. Dr. Atkins serves on advisory boards for Genentech, Bristol-Myers Squibb, and Prometheus.