Dr. Robert on Potential of Dabrafenib/Trametinib in Melanoma Brain Metastases

Caroline Robert, MD, PhD, head of the Dermatology Unit at the Institut Gustave-Roussey, co-director of the Melanoma Research Unit at INSERM 981 Paris-Sud University, explains why patients with melanoma and brain metastases were excluded from a trial evaluating the efficacy of dabrafenib (Tafinlar) plus trametinib (Mekinist).

Patients with brain metastases generally have a poor prognosis, says Robert. Prognosis is dependent upon the number of metastases and where they are located in the brain. A patient can have just 1 small lesion in a bad location and as such, will have a bad prognosis, she explains.

The combination of dabrafenib and trametinib showed positive results in patients with BRAF V600-mutated, unresectable and metastatic melanoma in a trial presented at the 2019 ASCO Annual Meeting. Although patients with brain metastases were excluded from the trial, trials exploring whether these patients could benefit from this treatment are underway. While early data show some efficacy with this combination in these patients, response rates were lower and less durable.

Going forward, Robert hopes to explore radiosurgery as well as focal radiotherapy with the addition of a targeted agent in patients with brain metastases.