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10.3390/cancers11121950
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Review

Efficacy and Adverse Events in Metastatic Melanoma Patients Treated with Combination BRAF Plus MEK Inhibitors Versus BRAF Inhibitors: A Systematic Review

by
Austin Greco
1,*,
Danish Safi
1,
Umang Swami
2,3,
Tim Ginader
4,5,
Mohammed Milhem
2,4 and
Yousef Zakharia
2,4
1
Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
2
Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242, USA
3
Department of Internal Medicine, Division of Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
4
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
5
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(12), 1950; https://doi.org/10.3390/cancers11121950
Received: 27 August 2019 / Revised: 16 October 2019 / Accepted: 28 November 2019 / Published: 5 December 2019
(This article belongs to the Special Issue Targeted Therapies for Melanoma)
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Abstract

We reviewed the literature to assess the efficacy and risk of constitutional, cardiac, gastrointestinal, and dermatological toxicities of combined BRAF plus MEK inhibitors versus BRAF inhibitors alone in patients with metastatic melanoma with BRAF mutations. Searches were conducted in PubMed, Cochrane Database of Systematic Reviews, Google scholar, ASCO, Scopus, and EMBASE for reports published from January 2010 through March 2019. Efficacy, including progression-free survival (PFS) and overall survival (OS) rates, were assessed by hazard ratio (HR); objective response rates (ORR) were assessed by odds ratio (OR). The randomized clinical trials (RCTs) with comparison to vemurafenib monotherapy were included to determine constitutional, gastrointestinal, cardiac, and dermatological toxicities using PRISMA statistical analysis with relative risk (RR) for equal comparison to avoid inclusion bias. Five RTCs comprising 2307 patients were included to assess efficacy, while three of the five RCTs comprising 1776 patients were included to assess adverse events. BRAF plus MEK inhibitor combination therapy demonstrated overall better efficacy compared to BRAF inhibitor monotherapy. Combination therapies appear to have favorable dermatologic side effect profiles, similar constitutional and cardiac profiles, and slightly worse gastrointestinal profiles compares to monotherapy regimens. View Full-Text
Keywords: adverse drug event; treatment outcome; melanoma; BRAF inhibition; MEK inhibition; encorafenib; binimetinib; dabrafenib; trametinib; cobimetinib; vemurafenib adverse drug event; treatment outcome; melanoma; BRAF inhibition; MEK inhibition; encorafenib; binimetinib; dabrafenib; trametinib; cobimetinib; vemurafenib
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MDPI and ACS Style

Greco, A.; Safi, D.; Swami, U.; Ginader, T.; Milhem, M.; Zakharia, Y. Efficacy and Adverse Events in Metastatic Melanoma Patients Treated with Combination BRAF Plus MEK Inhibitors Versus BRAF Inhibitors: A Systematic Review. Cancers 2019, 11, 1950. https://doi.org/10.3390/cancers11121950

AMA Style

Greco A, Safi D, Swami U, Ginader T, Milhem M, Zakharia Y. Efficacy and Adverse Events in Metastatic Melanoma Patients Treated with Combination BRAF Plus MEK Inhibitors Versus BRAF Inhibitors: A Systematic Review. Cancers. 2019; 11(12):1950. https://doi.org/10.3390/cancers11121950

Chicago/Turabian Style

Greco, Austin, Danish Safi, Umang Swami, Tim Ginader, Mohammed Milhem, and Yousef Zakharia. 2019. "Efficacy and Adverse Events in Metastatic Melanoma Patients Treated with Combination BRAF Plus MEK Inhibitors Versus BRAF Inhibitors: A Systematic Review" Cancers 11, no. 12: 1950. https://doi.org/10.3390/cancers11121950

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