First-line BRAF/MEK inhibitors versus anti-PD-1 monotherapy in BRAFV600-mutant advanced melanoma patients: a propensity-matched survival analysis

Jesper van Breeschoten, Michel W. J. M. Wouters, Doranne L. Hilarius, John B. Haanen, Christian U. Blank, Maureen J. B. Aarts, Franchette W. P. J. van den Berkmortel, Jan-Willem B. de Groot, Geke A. P. Hospers, Ellen Kapiteijn, Djura Piersma, Roos S. van Rijn, Karijn P. M. Suijkerbuijk, Willeke A. M. Blokx, Bert-Jan J. ten Tije, Astrid A. M. van der Veldt, Art Vreugdenhil, Marye J. Boers-Sonderen, Alfonsus J. M. van den Eertwegh

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Background: Anti-PD-1 antibodies and BRAF/MEK inhibitors are the two main groups of systemic therapy in the treatment of BRAF V600-mutant advanced melanoma. Until now, data are inconclusive on which therapy to use as first-line treatment. The aim of this study was to use propensity score matching to compare first-line anti-PD-1 monotherapy vs. BRAF/MEK inhibitors in advanced BRAF V600-mutant melanoma patients. Methods: We selected patients diagnosed between 2014 and 2017 with advanced melanoma and a known BRAF V600-mutation treated with first-line BRAF/MEK inhibitors or anti-PD-1 antibodies, registered in the Dutch Melanoma Treatment Registry. Patients were matched based on their propensity scores using the nearest neighbour and the optimal matching method. Results: Between 2014 and 2017, a total of 330 and 254 advanced melanoma patients received BRAF/MEK inhibitors and anti-PD-1 monotherapy as first-line systemic therapy. In the matched cohort, patients receiving anti-PD-1 antibodies as a first-line treatment had a higher median and 2-year overall survival compared to patients treated with first-line BRAF/MEK inhibitors, 42.3 months (95% CI: 37.3-NE) vs. 19.8 months (95% CI: 16.7–24.3) and 65.4% (95% CI: 58.1–73.6) vs. 41.7% (95% CI: 34.2–51.0). Conclusions: Our data suggest that in the matched BRAF V600-mutant advanced melanoma patients, anti-PD-1 monotherapy is the preferred first-line treatment in patients with relatively favourable patient and tumour characteristics.

Original languageEnglish
Pages (from-to)1222-1230
Number of pages9
JournalBritish journal of cancer
Issue number7
Early online date2021
Publication statusPublished - 30 Mar 2021

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