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Soo Park, MD
Soo Park, MD
Posted: Monday, June 10, 2024
To determine whether BRAF and MEK inhibitors followed by immunotherapy yields a benefit in survival compared with upfront immunotherapy alone in patients with BRAF V600E/K–mutant melanoma, Caroline Robert, MD, PhD, of Gustave Roussy Cancer Campus, University of Paris-Saclay, Villejuif, France, and colleagues assessed the use of the BRAF inhibitor encorafenib and the MEK inhibitor binimetinib followed by the CTLA-4 inhibitor ipilimumab and the PD-1 inhibitor nivolumab (EBIN) in a subset of this patient population. The results of this trial, which were presented during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract LBA9503), showed no difference in progression-free survival between the two treatment arms for unselected patients. However, patients with very high lactate dehydrogenase (LDH) levels and those with liver metastases may ultimately benefit from the sequential approach.
The phase II EBIN study included 267 patients with unresectable, BRAF V600E/K–mutated, stage III/IV melanoma (ClinicalTrials.gov identifier NCT03235245). Participants were randomly assigned 1:1 to receive upfront immunotherapy with ipilimumab plus nivolumab (arm A: n = 131) or encorafenib plus binimetinib followed by ipilimumab and nivolumab (arm B: n = 136), for up to 2 years.
The median follow-up was 21 months. Approximately 63% of patients had stage M1c melanoma, and 48% had a high LDH levels. Nearly all patients were progression-free at week 12 in arm B, but the progression-free survival was not significantly longer in these patients compared with those in arm A (hazard ratio = 0.87). In prespecified analyses, the hazard ratio for arm B vs arm A among patients with a high LDH level was 0.46 (P = .045). The objective response rate was slightly higher in arm B (53%) than in arm A (45%), and more patients in arm B reported grade 3 or higher adverse events (58% vs 51%).
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
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