Authors' Affiliation: Melanoma Institute Australia and the University of Sydney, Sydney, Australia.
Clin Cancer Res. 2014 Apr 15;20(8):2035-43. doi: 10.1158/1078-0432.CCR-13-2054. Epub 2014 Feb 28.
Dabrafenib and trametinib were approved for use as monotherapies in BRAF-mutant metastatic melanoma by the U.S. Food and Drug Administration (FDA) in 2013, and most recently, their use in combination has received accelerated FDA approval. Both drugs target the mitogen-activated protein kinase (MAPK) pathway: dabrafenib selectively inhibits mutant BRAF that constitutively activates the pathway, and trametinib selectively inhibits MEK1 and MEK2 proteins activated by RAF kinases. The phase III study of dabrafenib in BRAF(V600E) metastatic melanoma reported rapid tumor regression in most patients and a 59% objective RECIST response rate. The median progression-free survival (PFS) and overall survival (OS) were improved compared with dacarbazine. Toxicities were well tolerated and different from those reported for vemurafenib, the first FDA-approved BRAF inhibitor. Efficacy has been demonstrated in other BRAF-mutant genotypes. The phase III study of trametinib in BRAF inhibitor-naïve patients with BRAF(V600E) or BRAF(V600K) also showed benefit with a prolonged median PFS and OS compared with chemotherapy. Trametinib is ineffective in patients who have progressed on BRAF inhibitors. A phase II trial of combined dabrafenib and trametinib demonstrated higher response rates and longer median PFS than dabrafenib monotherapy, with less cutaneous toxicity. Here, we review the clinical development of both drugs as monotherapies and in combination, and discuss their role in the management of BRAF-mutant melanoma.
达布拉非尼和曲美替尼分别于 2013 年被美国食品和药物管理局(FDA)批准用于治疗 BRAF 突变型转移性黑色素瘤的单药治疗,最近,其联合应用也获得了 FDA 的加速批准。这两种药物都靶向丝裂原活化蛋白激酶(MAPK)通路:达布拉非尼选择性抑制持续激活该通路的突变 BRAF,而曲美替尼选择性抑制 RAF 激酶激活的 MEK1 和 MEK2 蛋白。III 期研究显示,达布拉非尼治疗 BRAF(V600E)转移性黑色素瘤可使大多数患者的肿瘤迅速消退,客观缓解率(RECIST)为 59%。与达卡巴嗪相比,中位无进展生存期(PFS)和总生存期(OS)得到了改善。毒性反应可耐受,与第一个获得 FDA 批准的 BRAF 抑制剂维莫非尼的毒性反应不同。在其他 BRAF 突变型中也证明了疗效。曲美替尼治疗 BRAF 抑制剂初治的 BRAF(V600E)或 BRAF(V600K)患者的 III 期研究也显示出获益,与化疗相比,中位 PFS 和 OS 延长。曲美替尼对接受过 BRAF 抑制剂治疗后进展的患者无效。一项达布拉非尼联合曲美替尼的 II 期试验显示,与达布拉非尼单药治疗相比,联合治疗的缓解率更高,中位 PFS 更长,皮肤毒性更小。在这里,我们回顾了这两种药物作为单药和联合用药的临床开发情况,并讨论了它们在 BRAF 突变型黑色素瘤治疗中的作用。