Trial results of vemurafenib, cobimetinib and LDH as a predictive marker in BRAF-mutated melanoma

Axel Hauschild, MD, PhD of University Hospital Schleswig-Holstein, Kiel, Germany, gives an overview of his talk on vemurafenib and cobimetinib for BRAF-mutated metastatic melanoma held at the 2016 World Congress on Cancers of the Skin (WCCS) and the Congress of the European Association of Dermato-Oncology (EADO) in Vienna, Austria. According to Prof. Hauschild, this trial (called coBRIM, NCT01689519) was similar to the trial on dabrafenib and trametinib (NCT01584648). The question was if the dual inhibition of crucial molecules of the signal transduction pathway is better than just knocking one of the molecules out. The answer is yes; the response rate was in the range of 70%, response duration was 13 months and the two year survival data is very promising (three year survival data is not available yet). Around 10-13% of patients had to discontinue treatment because of serious adverse events and some patients do not have any progressive disease after three years. For both clinical trials, he presented a subgroup analysis, which indicates that a simple serum marker like LDH (lactate dehydrogenase), is a good prognostic marker and a predictive marker for treatment outcome. The lower the LDH, the better the outcome for the patient. For patients with LDH that is elevated 2x or more, the prognosis is bad with low median overall survival (OS) and low chance for three year survival.