Identifying treatment options for BRAFV600 wild-type metastatic melanoma: A SU2C/MRA genomics-enabled clinical trial

• Published in: PloS one Vol. 16; no. 4; p. e0248097
• Main Authors: LoRusso, Patricia M, Sekulic, Aleksandar, Sosman, Jeffrey A, Liang, Winnie S, Carpten, John, Craig, David W, Solit, David B, Bryce, Alan H, Kiefer, Jeffrey A, Aldrich, Jessica, Nasser, Sara, Halperin, Rebecca, Byron, Sara A, Pilat, Mary Jo, Boerner, Scott A, Durecki, Diane, Hendricks, William P D, Enriquez, Daniel, Izatt, Tyler, Keats, Jonathan, Legendre, Christophe, Markovic, Svetomir N, Weise, Amy, Naveed, Fatima, Schmidt, Jessica, Basu, Gargi D, Sekar, Shobana, Adkins, Jonathan, Tassone, Erica, Sivaprakasam, Karthigayini, Zismann, Victoria, Calvert, Valerie S, Petricoin, Emanuel F, Fecher, Leslie Anne, Lao, Christopher, Eder, J Paul, Vogelzang, Nicholas J, Perlmutter, Jane, Gorman, Mark, Manica, Barbara, Fox, Lisa, Schork, Nicholas, Zelterman, Daniel, DeVeaux, Michelle, Joseph, Richard W, Cowey, C Lance, Trent, Jeffrey M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07-04-2021; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Benzimidazoles - administration & dosage; Biology and Life Sciences; Cancer; Cancer therapies; Clinical trials; Computer programs; Damage; Data analysis; Editing; Female; Funding; Genomics; Health care facilities; Health services; Humans; Immune checkpoint; Immunology; Immunotherapy; Interrogation; Male; Medical prognosis; Medical research; Medicine; Medicine and Health Sciences; Melanoma; Melanoma - drug therapy; Melanoma - genetics; Melanoma - metabolism; Melanoma, Cutaneous Malignant; Metastases; Metastasis; Methodology; Middle Aged; Mucosa; Mutation; Neoplasm Metastasis; Patients; Pilot Projects; Prospective Studies; Proteomics; Proto-Oncogene Proteins B-raf - genetics; Proto-Oncogene Proteins B-raf - metabolism; Skin; Skin Neoplasms - drug therapy; Skin Neoplasms - genetics; Skin Neoplasms - metabolism; Software; Survival; Therapy; Translation; Tumors; Visualization; Los Angeles California; Ann Arbor Michigan; United States > US; Detroit Michigan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248097

Although combination BRAF and MEK inhibitors are highly effective for the 40-50% of cutaneous metastatic melanomas harboring BRAFV600 mutations, targeted agents have been ineffective for BRAFV600wild-type (wt) metastatic melanomas. The SU2C Genomics-Enabled Medicine for Melanoma Trial utilized a Simon two-stage optimal design to assess whether comprehensive genomic profiling improves selection of molecular-based therapies for BRAFV600wt metastatic melanoma patients who had progressed on standard-of-care therapy, which may include immunotherapy. Of the response-evaluable patients, binimetinib was selected for 20 patients randomized to the genomics-enabled arm, and nine were treated on the alternate treatment arm. Response rates for 27 patients treated with targeted recommendations included one (4%) partial response, 18 (67%) with stable disease, and eight (30%) with progressive disease. Post-trial genomic and protein pathway activation mapping identified additional drug classes that may be considered for future studies. Our results highlight the complexity and heterogeneity of metastatic melanomas, as well as how the lack of response in this trial may be associated with limitations including monotherapy drug selection and the dearth of available single and combination molecularly-driven therapies to treat BRAFV600wt metastatic melanomas.