MEK Inhibition in melanoma – pro
OTELLIC (cobimetinib) is indicated for the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, in combination with ZELBORAF (vemurafenib). I do not see confirmation of BRAF600 positivity in the record, although the past use of trametinib presupposes such positivity.
The one study involving patients with advanced melanoma and the BRAF V600 mutation who had not previously had systemic treatment showed that that treatment with the combination of cobimetinib and vemurafenib has an advantage over vemurafenib used alone in terms of life expectancy: Half of the people who only received vemurafenib had passed away within about 17 months. Half of the group who received both cobimetinib and vemurafenib lived for at least another 21 months. The study provided weak evidence that tumor pain started later or worsened at a slower rate in patients who were treated with both cobimetinib and vemurafenib rather than vemurafenib only.There was weak evidence that the cobimetinib/vemurafib combination had an advantage here, with insomnia and exhaustion starting later than with vemurafenib alone.
Hair loss, dry and scaly skin: It is not only the tumor, but also the medication used that can cause these problems. There was weak evidence for an advantage here in people under 65 who received the cobimetinib / vemurafenib combination. No difference was found in patients over the age of 65.
OTELLIC (cobimetinib) is indicated for the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, in combination with ZELBORAF (vemurafenib).
Paolo A Ascierto, et al, Cobimetinib combined with vemurafenib in advanced BRAFV600-mutant melanoma (coBRIM): updated efficacy results from a randomised, double-blind, phase 3 trial Lancet Oncology Volume 17, No. 9, p12481260, September 2016
Douglas Johnson,Is There a Role for Single-Agent MEK Inhibition in Melanoma?
Clinical Advances in Hematology & Oncology December 2016 – Volume 14, Issue 12
Sosman JA, Kittaneh M, Lolkema MP, et al. A phase 1b/2 study of LEE011 in combination with binimetinib (MEK162) in patients with NRAS-mutant melanoma: early encouraging clinical activity [ASCO abstract 9009]. J Clin Oncol. 2014;32(15)(suppl).
It is not indicated or well supported for NRAS mutation as a single agent, see discussion by
Paolo A Ascierto, et al, Cobimetinib combined with vemurafenib in advanced BRAFV600-mutant melanoma (coBRIM): updated efficacy results from a randomised, double-blind, phase 3 trial Lancet Oncology Volume 17, No. 9, p12481260, September 2016
Douglas Johnson,Is There a Role for Single-Agent MEK Inhibition in Melanoma?
Clinical Advances in Hematology & Oncology December 2016 – Volume 14, Issue 12
Sosman JA, Kittaneh M, Lolkema MP, et al. A phase 1b/2 study of LEE011 in combination with binimetinib (MEK162) in patients with NRAS-mutant melanoma: early encouraging clinical activity [ASCO abstract 9009]. J Clin Oncol. 2014;32(15)(suppl).