Dr. Gibney on Selecting Between BRAF Inhibitor Regimens in Melanoma

Geoffrey T. Gibney, MD, co-leader, Melanoma Disease Group and a member of the Developmental Therapeutics (Phase I) program at the Lombardi Comprehensive Cancer Center and MedStar Cancer Network, MedStar Georgetown University Hospital, discusses selecting between BRAF inhibitor regimens in melanoma.

Patients with BRAF-mutant unresectable stage III or active stage IV melanoma can receive BRAF-targeted therapy or immunotherapy with anti–PD-L1 agents, Gibney explains.

If targeted therapy is selected, choosing between available BRAF inhibitor combinations can be challenging, says Gibney.

Currently, 3 doublets are approved by the FDA for this indication: dabrafenib (Tafinlar)/trametinib (Mekinist), encorafenib (Braftovi)/binimetinib (Mektovi), and vemurafenib (Zelboraf)/cobimetinib (Cotellic).

Data show similar rates of efficacy with these regimens, Gibney says. Although slight differences in toxicities have been observed, the rates of serious grade 3 or 4 toxicities are comparable. Moreover, around 15% of patients permanently discontinue treatment irrespective of which regimen is used.

As such, dosing schedules, individual toxicities, and patient preference play significant roles in informing the optimal regimen, concludes Gibney.