BRAF-mutant melanoma management: a single center retrospective analysis of patients treated with sequential therapy

Aims: In treating patients with melanoma, the order in which therapy is administered, choosing between targeted therapy and immune checkpoint inhibition, has garnered growing interest. Patients and Methods: We conducted a retrospective, real-world analysis of patients with advanced melanoma undergoing immunotherapy or targeted therapy as first-line at a single center. Results: A total of 88 patients diagnosed with melanoma were identified. At 7 years, in this cohort, 68.4% (95% CI: 55.9%-83.6%) of patients were alive. In all, 47 tumors harbored BRAF mutations; 10 patients who did not receive therapy were excluded from this subgroup. Of the 37 patients with a BRAF mutation, 29 received first-line targeted therapy and 8 received first-line immunotherapy. At 2 years, 28 (76%) patients were alive and 9 (24%) had died. Of the 28 survivors, 22 received first-line targeted therapy and 6 received first-line immunotherapy. In addition, 29 patients were administered a MEK inhibitor in first line. Of these, 66.4% (95% CI: 48.3–91.2) of patients were alive at 7 years. Conclusions: There was no significant difference between survival and first-line immunotherapy or first-line targeted therapy. Additional studies are required to establish whether front-line immunotherapy is linked to more effective long-term disease control compared to first-line targeted therapy.