Department of Medical Oncology, Royal Marsden Hospital, London, England.
Department of Internal Medicine, University of Michigan, Ann Arbor3Department of Dermatology, University of Michigan, Ann Arbor.
JAMA Oncol. 2015 Jul;1(4):433-40. doi: 10.1001/jamaoncol.2015.1184.
IMPORTANCE: The anti-PD-1 therapeutic antibody, nivolumab, has demonstrated clinical activity in patients with advanced melanoma. The activity of nivolumab in subgroups of patients with tumors which have wild-type BRAF kinase vs patients with tumors having mutant BRAF has not systematically been explored in a large dataset. OBJECTIVE: To evaluate the efficacy and safety of nivolumab in patients with wild-type BRAF and mutant BRAF metastatic melanoma. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective analysis of data pooled from 4 clinical trials of nivolumab in 440 adult patients with unresectable stage III or stage IV melanoma, who had been tested for BRAF mutational status while participating in one of the studies. INTERVENTION: The investigational drug, nivolumab, was administered intravenously to study participants over a 60-minute period, at doses of 0.1, 0.3, 1.0, 3.0, or 10.0 mg/kg every 2 weeks until disease progression, discontinuation owing to adverse events, withdrawal, or end of study. Most patients (83%) received nivolumab at a dosage of 3 mg/kg. MAIN OUTCOME AND MEASURE: Best overall response by modified World Health Organization or Response Evaluation Criteria In Solid Tumors criteria and safety profile. RESULTS: Of a total of 440 patients from 4 nivolumab clinical trials included in the analysis, 334 were BRAF wild-type and 106 were positive for BRAF V600 mutation. With the exception of prior BRAF inhibitor therapy, the demographics were well balanced between the 2 cohorts. In patients evaluable for response, the objective response rates were 34.6% (95% CI, 28.3-41.3) for the 217 patients with wild-type BRAF status and 29.7% (95% CI, 19.7-41.5) for the 74 with mutant BRAF status. The objective response rates did not seem to be affected by prior BRAF inhibitor therapy, prior ipilimumab therapy, or PD-L1 status of the tumor. The median duration of objective response was 14.8 months (95% CI, 11.1-24.0 months) for wild-type BRAF and 11.2 months (95% CI, 7.3-22.9 months) for mutant BRAF. Median time to objective response was 2.2 months in both patient groups. The incidence of treatment-related adverse events of any grade was 68.3% in the wild-type BRAF group and 58.5% in the mutant BRAF group, with grade 3 or 4 adverse events in 11.7% and 2.8% of patients, respectively. Treatment-related AEs of any grade that occurred in at least 5% of patients in either group were fatigue, pruritus, rash, and diarrhea. CONCLUSIONS AND RELEVANCE: The results of this retrospective analysis suggest that nivolumab has similar efficacy and safety outcomes in patients with wild-type or mutant BRAF, regardless of prior BRAF inhibitor or ipilimumab treatment.
重要性:抗 PD-1 治疗性抗体nivolumab 已在晚期黑色素瘤患者中显示出临床活性。在大型数据集的系统探索中,nivolumab 在具有野生型 BRAF 激酶的肿瘤患者亚组与具有突变型 BRAF 的肿瘤患者中的活性尚未得到充分研究。
目的:评估 nivolumab 在野生型 BRAF 和突变型 BRAF 转移性黑色素瘤患者中的疗效和安全性。
设计、地点和参与者:这是对 nivolumab 在 4 项临床试验中 440 名不可切除的 III 或 IV 期黑色素瘤成年患者数据的回顾性分析,这些患者在其中一项研究中接受了 BRAF 突变状态检测。
干预措施:研究药物 nivolumab 以 60 分钟的静脉输注,剂量为 0.1、0.3、1.0、3.0 或 10.0mg/kg,每 2 周一次,直至疾病进展、因不良事件停药、退出或研究结束。大多数患者(83%)以 3mg/kg 的剂量接受 nivolumab。
主要结果和测量指标:根据改良的世界卫生组织或实体瘤反应评价标准的最佳总体反应和安全性概况。
结果:在分析中包括的 4 项 nivolumab 临床试验的 440 名患者中,334 名患者 BRAF 野生型,106 名患者 BRAF V600 突变阳性。除了先前的 BRAF 抑制剂治疗外,两组的人口统计学特征基本平衡。在可评估反应的患者中,217 名野生型 BRAF 状态患者的客观缓解率为 34.6%(95%CI,28.3-41.3),74 名突变型 BRAF 状态患者的客观缓解率为 29.7%(95%CI,19.7-41.5)。客观缓解率似乎不受先前的 BRAF 抑制剂治疗、先前的 ipilimumab 治疗或肿瘤 PD-L1 状态的影响。野生型 BRAF 的客观缓解中位持续时间为 14.8 个月(95%CI,11.1-24.0 个月),突变型 BRAF 为 11.2 个月(95%CI,7.3-22.9 个月)。客观缓解的中位时间在两组患者中均为 2.2 个月。野生型 BRAF 组和突变型 BRAF 组任何级别治疗相关不良事件的发生率分别为 68.3%和 58.5%,分别有 11.7%和 2.8%的患者发生 3 级或 4 级不良事件。在两组中至少有 5%的患者发生的任何级别的治疗相关不良事件是疲劳、瘙痒、皮疹和腹泻。
结论和相关性:这项回顾性分析的结果表明,nivolumab 在野生型或突变型 BRAF 患者中的疗效和安全性结果相似,无论是否存在先前的 BRAF 抑制剂或 ipilimumab 治疗。
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