Dr. Flaherty on Second-Line Therapy for BRAF-Mutant Melanoma

Keith T. Flaherty, MD, professor of medicine, Harvard Medical School, director, Henri and Belinda Termeer Center for Targeted Therapy, director of clinical research, Massachusetts General Hospital, discusses treatment beyond frontline therapy for patients with BRAF-mutant relapsed/refractory melanoma.

For patients without a BRAF mutation, physicians only deliberate on immunotherapy options, including monotherapy or combination therapy, says Flaherty. Treatment is more complicated for the BRAF-mutant population because there are more options and clinical trials; however, most of these clinical trials examine treatment-naïve patients, meaning these treatments are not looked at in the second-line setting and beyond, explains Flaherty.

Lack of trials looking at treatment beyond the frontline setting makes it difficult to talk to patients about whether immunotherapy or targeted therapy is the right upfront approach, according to Flaherty. The COLUMBUS data became helpful when combined with other data sets. This long-term follow-up data is helping physicians understand the likelihood of a patient responding to treatment based on their disease characteristics. Currently, targeted therapy and immunotherapy look highly comparable as second-line therapies; therefore, understanding the molecular features of patients to identify those who are more likely to get long-term benefit from the available therapies, Flaherty concludes.