The Gustave Roussy Institute demonstrates the benefits of targeted dual therapy in the treatment of metastatic melanoma. A first for this type of cancer that is difficult to treat.
Cutaneous melanoma is one of the cancers whose incidence and mortality have risen sharply since the 1980s, in particular because of our exposure to the sun and UV tanning centers, which drain our sun capital and promote the appearance of cancerous lesions. In 2017, 15,404 melanomas were diagnosed in France and 1,783 deaths were deplored.
A clinical trial led by the Institut Gustave Roussy, presented at the congress of theAmerican Society of Clinical Oncology (ASCO) and published simultaneously in the New England Journal of Medicine, demonstrates the benefits of targeted dual therapy in the treatment of metastatic melanoma with a BRAF V600 mutation.
This mutation of the gene called “BRAF”, plays a role in the very rapid proliferation of tumor cells. It makes this type of melanoma difficult to treat. Until the introduction of this dual therapy, metastatic melanoma had a very unfavorable prognosis.
Benefits confirmed at four and five years
But the combination of dabrafenib and trametinib, two anti-cancer drugs that target an intracellular signaling pathway specifically involved in the cancerous process, seems to prolong progression-free survival and improve the overall survival of many patients. Data from 563 patients with metastatic melanoma with a BRAF mutation receiving two daily doses of 150 mg dabrafenib and one daily dose of trametinib 2 mg were analyzed.
“The first results at three years (…) published in 2017, showed that the disease had not progressed in 23% of patients and that 44% were still alive”, specifies the Gustave Roussy Institute in a communicated. In this new study, “these benefits are confirmed at four and five years with stabilized disease in 21 and 19% of patients respectively, and overall survival rates reaching 37 and 34%”.
Disparities between patients
However, the researchers observed disparities among the patients, depending on the number of metastases and the levels of serum LDH (lactatodehydrogenases, enzymes whose high level indicates the aggressiveness of the melanoma).
“25% of patients whose disease had not progressed had normal LDH levels, compared to only 8% in those with high levels; the overall survival rate was also considerably higher, 43% vs 16%; In those with both a normal LDH level and less than three metastatic sites, these rates were 31% and 55% respectively.
Note that thealmost all of the participants (98%) experienced adverse effects (98%), “but all were known and expected (fever, rashes, diarrhoea, etc.) different from those observed with anti-PD1 immunotherapy “. 18% of patients were still forced to interrupt their treatment.
“Nearly 20% of patients respond to this targeted dual therapy”
Overall, “an objective response is obtained in 68% of treated patients, reports the Pre Caroline Robert, Head of the Dermatology Department at Gustave Roussy. And nearly 20% of patients respond completely to this targeted dual therapy and no longer show any visible metastases after only a few months of treatment.
These good results should not, however, hide a still high death rate: 62% at the time of the data analysis. “Even if the progress made for several years is significant, we still deplore a lot of deaths at five years old”, tempers the Pre Robert, who specifies that other studies are being carried out on the subject.
.
