Melanoma: COMBI-d trial

Abbreviations

No EU-CTR

  • COMBI-d references
    2014-11-13
    G.V. Long
    Combined BRAF and MEK Inhibition versus BRAF Inhibition Alone in Melanoma
Investigated (inv)
Comparator (comp)

DABR+TRAM

DABR+PLB

211

212

Phase:

3

Randomisation:

Double blind

Primary tumour:

Melanoma

Subtype (biomarker):

V600E MT, V600K MT

Stage:

meta

Line of therapy:

L1

Primary
DABR+TRAM
DABR+PLB
HR
p
PFS
9.3 mo
8.8 mo
0.75 (0.57-0.99)
0.03
Secondaries
DABR+TRAM
DABR+PLB
HR
p
OS @6mo
93%
85%
0.63 (0.42-0.94)
NSS
OS
NR
NR
0.63 (0.42–0.94)
0.02
ORR
67%
51%
0.002
DoR
9.2 mo
10.2 mo
(all grades, %)
DABR+TRAM
DABR+PLB
p
Pyrexia
51
28
NA
Nausea
30
26
NA
Diarrhea
24
14
NA
Rash
23
22
NA
Hypertension
22
14
NA
Vomiting
20
14
NA
Elevated ALTdc-comma AST
22
8
NA
Constipation
11
<1
NA
Back pain
9
14
NA
Hand–foot syndrome
5
27
NA
Hyperkeratosis
3
32
NA
Skin papilloma
1
21
NA
  • Inclusion
  • Exclusion

- Histologically confirmed cutaneous melanoma that is either Stage IIIC (unresectable) or Stage IV (metastatic), and determined to be BRAF V600E/K mutation-positive using the bioMerieux (bMx) investigational use only (IUO) THxID BRAF Assay (IDE: G120011). The assay will be conducted by a central reference laboratory. Subjects with ocular or mucosal melanoma are not eligible. - The subject must have a radiologically measurable tumor - The subject is able to carry out daily life activities without significant difficulty (ECOG performance status score of 0 or 1). - Able to swallow and retain oral medication - Sexually active subjects must use acceptable methods of contraception during the course of the study - Adequate organ system function and blood counts.

- Prior treatment with a BRAF or a MEK inhibitor - Prior systemic anti-cancer treatment for Stage IIIC (unresectable) or Stage IV (metastatic) melanoma. Prior systemic treatment in the adjuvant setting is allowed. (Note: Ipilimumab treatment must end at least 8 weeks prior to randomization.) - The subject has received major surgery or certain types of cancer therapy within 21 days of starting treatment - Current use of prohibited medication listed in the protocol - Left ventricular ejection fraction less than the lower limit of normal - Uncontrolled blood pressure - History or current evidence of retinal vein occlusion or central serous retinopathy - Brain metastases unless previously treated with surgery or stereotactic radiosurgery and the disease has been stable for at least 12 weeks - The subject is pregnant or nursing.

Characteristics
DABR+TRAM
DABR+PLB
Agedc-comma sexdc-comma previous immunotherapy
Median age (range) yr
55.0 (22–89)
56.5 (22–86)
Male - no.(%)
111 (53)
114 (54)
Previous immunotherapy - no.(%)
56 (27)
61 (29)
ECOG - no.(%)
0
155 (74)
150 (71)
1
55 (26)
61 (29)
BRAF mutation - no.(%)
V600E
179 (85)
181 (85)
V600K
32 (15)
30 (14)
Tumor stage - no.(%)
IVM1c
142 (67)
138 (65)
IIIcdc-comma IVM1adc-comma or IVM1b
69 (33)
73 (34)
Metastasis stage - no.(%)
M0
5 (2)
10 (5)
M1a
19 (9)
31 (15)
M1b
45 (21)
32 (15)
M1c
142 (67)
138 (65)
LDH level - no.(%)
>ULN
77 (37)
71 (34)
≤ULN
133 (63)
140 (66)
Visceral disease - no.(%)
Yes
165 (78)
145 (68)
No
46 (22)
66 (31)
No. of disease sites - no.(%)
≤2
109 (52)
119 (56)
≥3
101 (48)
92 (44)
Ad-hoc:
no.pts inv.
no.pts comp.
DABR+TRAM
DABR+PLB
HR
p
PFS (LDH high)
77
71
7.1 mo.
3.8 mo.
0.64 (0.42-0.95)
-
OS (LDH high)
77
71
13.7 mo.
8.9 mo.
0.48 (0.29-0.80)
-
  • PFS
analisys of PFS
DABR+TRAM
DABR+PLB
HR (95% CI)
BRAF mutation (*=the upper limit of 95%CI≥1)
V600K
0.68*
V600E
0.81*
LDH
≤ULN
0.83*
>ULN
0.64
Tumor stage
IIIcdc-comma IVM1adc-comma or IVM1b
0.90*
IVM1c
0.74*
ECOG
0
0.93*
1
0.75*
Visceral disease
Yes
0.76*
No
0.72*
No. of disease sites
≤2
1.02*
≥3
0.60
Age
<65 yr
0.71
≥65 yr
1.09*
Sex
Male
0.86*
Female
0.73*
analisys of
DABR+TRAM
DABR+PLB
HR (95% CI)