A step closer to determining the best sequential approach for treatment of BRAF-mutated metastatic melanoma?

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Data from SECOMBIT provide useful insights to the optimal sequence of immune checkpoint inhibitor therapy and targeted treatment combinations for patients with BRAF-mutated, advanced melanoma 

Treatment with ipilimumab plus nivolumab then encorafenib plus binimetinib or a ‘sandwich’ strategy may help to improve survival rates, according to results from the phase II SECOMBIT (Sequential Combo Immuno and Target Therapy) study presented today at the ESMO Congress 2021 (LBA40).

The study is examining three different sequential approaches: encorafenib plus binimetinib followed by ipilimumab plus nivolumab at the time of disease progression (arm A), the same therapies in reverse order (arm B), and a ‘sandwich’ strategy that involves encorafenib plus binimetinib for 8 weeks, then a change to ipilimumab and nivolumab and a return to encorafenib plus binimetinib at the time of disease progression (arm C).

In 206 patients with untreated BRAF-mutated metastatic melanoma who received at least one dose of study treatment, the median follow-up was 32.2 months. Results for 2- and 3-year survival rates showed a trend towards more favourable effects with ipilimumab plus nivolumab then encorafenib plus binimetinib (arm B: 73% and 62%, respectively) and with the sandwich strategy (arm C: 69% and 60%, respectively) compared with encorafenib plus binimetinib then ipilimumab plus nivolumab (arm A: 65% and 54%, respectively) (Figure). Similar effects were seen with 2- and 3-year total progression-free survival rates (arm B: 65% and 53%; arm C: 57% and 54%; arm A: 46% and 41%, respectively).

LBA40_ESMO 2021

Figure. A trend towards more favourable survival rates at 2 and 3 years were evident for arms B and C compared with arm A (Abstract LBA40, ESMO 2021)

Data on survival continue to be collected and results from a parallel biomarker analysis on resistance mechanisms will help provide further insights. 

Ascierto P A et al. SECOMBIT: the best sequential approach with combo immunotherapy [ipilimumab (I) /nivolumab (N)] and combo target therapy [encorafenib (E)/binimetinib (B)] in patients with BRAF mutated metastatic melanoma. A phase II randomized study. ESMO Congress 2021, LBA40

Mini oral session – Melanoma and other skin tumours, 20.9.2021, h. 17:55 – 18:00, Channel 2

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