Combination Atezolizumab, Cobimetinib, and Vemurafenib as a Treatment Option in BRAF V600 Mutation–Positive Melanoma: Patient Selection and Perspectives

Abstract

Michelle M Dugan,1 Matthew C Perez,1 Lilit Karapetyan,1,2 Jonathan S Zager1,2 1Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA; 2Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USACorrespondence: Jonathan S Zager, Chief Academic Officer, Directory of Regional Therapies, Senior Member, Department of Cutaneous Oncology, Moffitt Cancer Center, McKinley Drive Room 4123, Tampa, FL, 33612, USA, Tel [phone], Fax [phone], Email [email protected]: The treatment landscape for advanced and metastatic melanoma has drastically changed in recent years, with the advent of novel therapeutic options such as immune checkpoint inhibitors and targeted therapies offering remarkable efficacy and significantly improved patient outcomes compared to traditional approaches. Approximately 50% of melanomas harbor activating BRAF mutations, with over 90% resulting in BRAF V600E. Tumors treated with BRAF inhibitor monotherapy have a high rate of developing resistance within six months. Combination therapy with MEK inhibitors helped to mitigate this treatment resistance and led to improved outcomes. Due to the up-regulation of PD-1/PD-L1 receptors in tumors treated with BRAF/MEK inhibitor therapy, further studies included a third combination agent, anti-PD-1/PD-L1 inhibitors. This triple combination therapy may have superior efficacy and a manageable safety profile when compared with single or double agent therapy regimens.Plain Language Summary: Effective treatment of advanced and metastatic melanoma can be challenging. Newer treatment methods for patients with BRAF-mutated tumors include a combination of drugs with different complementary mechanisms. These drugs include BRAF-inhibitors, MEK-inhibitors, and PD-1/PD-L1 inhibitors. When these three medications are used in combination, patients may have better response rates and survival outcomes, when compared to using just one or two of these medications together. Toxicity rates are higher with a triple-medication regimen, so careful patient selection is important to consider.Keywords: BRAF inhibitor, MEK inhibitor, metastatic melanoma, BRAF-mutant melanoma, combination BRAF therapy, triple therapy

Keywords

• braf inhibitor
• mek inhibitor
• metastatic melanoma
• braf-mutant melanoma
• combination braf therapy
• triple therapy