Retrospective review of outcomes associated with metastatic melanoma patients treated with 1st‐line BRAF‐targeted therapy

BRAF‐mutant melanoma patients can theoretically access both immunotherapy and BRAF‐targeted therapy as treatment for metastatic disease. BRAF‐targeted therapy is increasingly used 1st line for poorer prognostic patients, so we wanted to assess realistic expectations of these patients accessing 2nd‐line immunotherapy. We conducted a retrospective review of clinical outcomes in 25 patients treated over the last 3 years with 1st‐line BRAF‐targeted therapy in a real‐world clinical setting at a UK‐based tertiary centre. Compared with the registration trials, our patients receiving 1st‐line BRAF‐targeted therapy had poorer performance status, higher disease burden, shorter median progression‐free survival (5.05 months, 95% CI: 3.96–8.88) and shorter median overall survival (11.5 months, 95% CI: 6.24 – not reached). Overall response rate was similar, at 64%. On disease progression, median survival was 2.34 months (95% CI: 1.62 – not reached). Only five patients went on to receive 2nd‐line immunotherapy. Metastatic melanoma patients treated with 1st‐line BRAF‐targeted therapy now have different demographics compared with those recruited to registration trials conducted over the last 10 years. In a modern‐day, real‐world setting, these patients should be counselled that only 1 in 5 are likely to receive 2nd‐line immunotherapy and their survival times are expected to be short.