[5 min read] First-line treatment decisions for BRAF-mutated melanoma

How do you determine first-line treatment for your patients with melanoma? Treatment decisions for advanced melanoma are increasingly complex and guidelines provide limited advice on how to choose between immunotherapy and targeted therapy for first-line treatment. A Delphi study was carried out to understand which patient characteristics and disease-related factors inform clinicians’ choices of first-line treatment for BRAF-mutated melanoma.

Twelve European melanoma specialists experienced in using immunotherapies and targeted agents participated in a double-blind two-phase Delphi study.
In phase 1, participants completed a questionnaire developed after reviewing patient characteristics and disease-related factors reported in trials, clinical guidelines, and health technology assessments.
Phase 2 was an expert panel meeting to explore outstanding issues from phase 1 and seek consensus, defined as 80% agreement.
Twenty patient-related and disease-related characteristics were considered. There was consensus that tumour burden (83% of clinicians) and disease tempo (83%) are very or extremely important factors when selecting first-line treatment.
Several components were deemed important when assessing tumour burden: brain metastases (82% of clinicians) and location of metastases (89%).
There was consensus that disease tempo can be quantified in clinical practice, but not on a formal classification applicable to all patients.
Lactate dehydrogenase level is a component of both tumour burden and disease tempo; all clinicians considered lactate dehydrogenase important when choosing first-line treatment. The majority (92%) did not routinely test programmed death ligand-1 status in patients with melanoma.
Clinicians agreed that choosing a first-line treatment for advanced melanoma is a complex, multifactorial process and that clinical judgement remains the most important element of decision-making until research can provide clinicians with better scientific parameters and tools for first-line decision-making.
Source: Paolo Ascierto et al. The impact of patient characteristics and disease-specific factors on first-line treatment decisions for BRAF-mutated melanoma: results from a European expert panel study. Ovid. Melanoma Research. 28(4):333–340, AUG 2018 DOI: 10.1097/CMR.0000000000000455, PMID: 29750751. Publication Date: 2018/08/01

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