Comparison between first-line target therapy and immunotherapy in different prognostic categories of BRAF mutant metastatic melanoma patients

Background: BRAF and MEK inhibitors target therapies (TT) and AntiPD1 immunotherapies (IT) are available first-line treatments for BRAF v600 mutant metastatic melanoma patients (pts). ECOG PS (E), baseline LDH (L), baseline number of metastatic sites (N)are well known clinical prognostic markers that identify different prognostic categories of pts. Direct comparison between first-line TT and IT in different prognostic categories could help in first-line treatment decision. Methods: This is a retrospective analysis conducted in 14 Italian centers. We analyzed data about 454 metastatic melanoma pts (without brain metastasis), Pts were divided in three different prognostic risk categories: group A: pts with E=0, L within normal range, and N less than 3; group B: pts not included in group A or C; group C: pts with E>0, L over the normal range, and N more than 3. For each prognostic group we compared TT and IT in terms of PFS, OS, DCR. Results: In the table we report the comparison between TT and IT in groups A, B, C, in terms of PFS, OS, DCR. [Formula presented] Conclusions: In good prognosis group A (baseline ECOG PS 0, LDH within normal range, <3 metastatic sites) TT showed statistically significant better PFS than IT, also in a long term period, suggesting that TT can be a good first-line option for this pts category. Only in Group B we observed a crossing of the survival curves after the 3rd year of observation in favor of IT. Few pts were enrolled in group C, so few conclusion can be made about it, even if TT showed grater efficacy. DCR was better for TT in all groups.