First-line pembrolizumab versus dabrafenib/trametinib treatment for BRAF V600–mutant advanced melanoma

Chang Gon Kim, Miso Kim, Jieon Hwang, Seung Tae Kim, Minkyu Jung, Kyoo Hyun Kim, Kyung Hwan Kim, Jee Suk Chang, Woong Sub Koom, Mi Ryung Roh, Kee Yang Chung, Tae Min Kim, Sang Kyum Kim, Jeeyun Lee, Sang Joon Shin

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Limited data are available to assist the selection between immune checkpoint inhibitors and BRAF/mitogen-activated protein kinase kinase inhibitors as first-line treatment for patients with BRAF-mutant advanced malignant melanoma. Objective: To investigate the outcomes associated with first-line pembrolizumab or dabrafenib/trametinib treatment for advanced melanoma with activating BRAF V600 mutation. Methods: Data of patients with BRAF V600–mutant melanoma who were treated with first-line pembrolizumab (n = 40) or dabrafenib/trametinib (n = 32) were analyzed. Tumor response, progression-free survival, and overall survival were evaluated. Immune evasion accompanied with emerging resistance to BRAF/mitogen-activated protein kinase kinase inhibitors was assessed. Results: A longer overall survival was observed after first-line pembrolizumab treatment than after first-line dabrafenib/trametinib treatment (hazard ratio = 2.910, 95% CI: 1.552-5.459), although there were no significant differences in progression-free survival (P = .375) and response rate (P = .123). Emergence of resistance to dabrafenib/trametinib co-occurred with immune evasion, enabling melanoma cells to escape recognition and killing by Melan-A–specific CD8+ T cells. Limitations: Analysis was conducted in a retrospective manner. Conclusion: Pembrolizumab may be recommended over BRAF/mitogen-activated protein kinase kinase inhibitors as the first-line treatment in patients with advanced BRAF V600–mutant melanoma.

Original languageEnglish
Pages (from-to)989-996
Number of pages8
JournalJournal of the American Academy of Dermatology
Issue number5
Publication statusPublished - 2022 Nov

Bibliographical note

Funding Information:
Funding sources: This work was supported by Internal Medicine Research Grant of Yonsei University College of Medicine .

Publisher Copyright:
© 2022 American Academy of Dermatology, Inc.

All Science Journal Classification (ASJC) codes

  • Dermatology


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