Abstract：
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.
摘要：
BRAF突变黑色素瘤患者理论上可以获得免疫治疗和BRAF靶向治疗作为转移性疾病的治疗。BRAF靶向治疗越来越多地用于预后较差的患者，因此,我们希望评估这些患者接受二线免疫疗法的现实期望.我们对在过去3年中接受一线BRAF靶向治疗的25名患者的临床结果进行了回顾性回顾，该患者在英国的三级中心的实际临床环境中接受了一线BRAF靶向治疗。与注册试验相比，我们接受一线BRAF靶向治疗的患者表现状况较差，较高的疾病负担，中位无进展生存期较短(5.05个月，95%CI：3.96-8.88）和较短的中位总生存期（11.5个月，95%CI：6.24-未达到）。总体反应率相似，在64%。关于疾病进展，中位生存期为2.34个月(95%CI:1.62-未达到).只有5名患者继续接受二线免疫疗法。与过去10年进行的注册试验相比，接受一线BRAF靶向治疗的转移性黑色素瘤患者现在具有不同的人口统计学特征。在现代，真实世界的设置，应提醒这些患者,只有1/5的患者可能接受二线免疫疗法,并且他们的生存时间预计较短.
