Glutsch Valerie, Amaral Teresa, Garbe Claus, Thoms Kai-Martin, Mohr Peter, Hauschild Axel, Schilling Bastian
Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Str. 2, DE-97080 Würzburg, Germany.
Acta Derm Venereol. 2020 Jun 11;100(13):adv00174. doi: 10.2340/00015555-3526.
The approval of BRAF and MEK inhibitors has significantly improved treatment outcomes for patients with BRAF-mutated metastatic melanoma. The 3 first-line targeted therapy trials have provided similar results, and thus the identification of predictive biomarkers may generate a more precise basis for clinical decision-making. Elevated baseline lactate dehydrogenase (LDH) has already been determined as a strong prognostic factor. Therefore, this indirect analysis compared subgroups with elevated baseline LDH across the pivotal targeted therapy trials co-BRIM, COMBI-v and COLUMBUS part 1. The Bucher method was used to compare progression-free survival, objective response rate and overall survival indirectly. The results show a non-significant risk reduction for progression in the subgroup with elevated baseline LDH receiving vemurafenib plus cobimetinib compared with dabrafenib plus trametinib and encorafenib plus binimetinib. Although an indirect comparison, these data might provide some guidance for treatment recommendations in melanoma patients with elevated LDH.
BRAF和MEK抑制剂的获批显著改善了BRAF突变型转移性黑色素瘤患者的治疗效果。三项一线靶向治疗试验取得了相似的结果，因此，预测性生物标志物的鉴定可能为临床决策提供更精确的依据。基线乳酸脱氢酶（LDH）升高已被确定为一个强有力的预后因素。因此，这项间接分析比较了关键靶向治疗试验co-BRIM、COMBI-v和COLUMBUS第1部分中基线LDH升高的亚组。采用布彻方法间接比较无进展生存期、客观缓解率和总生存期。结果显示，与达拉非尼加曲美替尼以及恩考芬尼加比美替尼相比，基线LDH升高的亚组接受维莫非尼加考比替尼治疗时进展风险降低不显著。尽管是间接比较，但这些数据可能为LDH升高的黑色素瘤患者的治疗建议提供一些指导。
