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Soo Park, MD
Soo Park, MD
Posted: Tuesday, June 25, 2024
Citing positive preliminary results of clinical trials evaluating the use of neoadjuvant immune checkpoint blockade and targeted therapy in patients with high-risk, resectable melanoma, Paolo Antonio Ascierto, BC, MD, of Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy, and colleagues conducted a randomized, noncomparative phase II trial examining neoadjuvant plus adjuvant use of the two therapies—administered in combination or in sequence—among this patient population before surgery (complete lymph node dissection). The investigators found that patients treated first with the kinase inhibitors vemurafenib and cobimetinib had the best response to neoadjuvant therapy, but those who received the monoclonal antibody atezolizumab in addition to the targeted agents as neoadjuvant treatment had better relapse-free survival. They presented their findings during the 2024 American Society for Clinical Oncology (ASCO) Annual Meeting (Abstract LBA9513).
A total of 95 patients with resectable, stage IIIB/IV, BRAF-mutant melanoma were included in the study. The median age of participants was 59, 29% were female, 60% had clinical stage IIIC melanoma, and median follow-up was 17 months. Participants were randomly assigned to receive neoadjuvant vemurafenib and cobimetinib for 6 weeks or a triplet combination of vemurafenib and cobimetinib plus atezolizumab, followed by surgery. Patients with BRAF wild-type melanoma received neoadjuvant cobimetinib and atezolizumab. All patients then received 17 cycles of atezolizumab after complete lymph node dissection.
The investigators reported that a major pathologic response (defined as pathologic complete response or near-pathologic complete response) was reached in 45% of patients who received vemurafenib and cobimetinib, 34% of those who received the triplet combination, and 36% of those who received cobimetinib and atezolizumab. Furthermore, they reported that 17%, 14%, and 16% of patients in each respective group did not have surgery, and relapse-free survival rates at 12 months were 78%, 86%, and 82%, respectively. Finally, the researchers noted that biomarker analysis is ongoing and that grade 3 to 4 toxicity was observed in 38%, 24%, and 22% of participants, respectively.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
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