volume 19 issue 4 pages 510-520

Adjuvant vemurafenib in resected, BRAFV600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial

Paolo A. Ascierto
Grant R. Goodman
Brian Simmons
Chenglin Ye
Yibing Yan
Gabriela Cinat
Luis Enrique Fein
Michael Brown
Alexander Guminski
Andrew Haydon
Adnan Khattak
Catriona McNeil
Phillip Parente
Jeremy Power
Rachel Roberts-Thomson
Shahneen Sandhu
Craig Underhill
Suresh Varma
Thomas Berger
Ahmad Awada
Nathalie Blockx
Véronique Buyse
Jeroen Mebis
Fabio Andre Franke
Sergio Jobim De Azevedo
Nicolas Silva Lazaretti
Rahima Jamal
Catalin Mihalcioiu
Teresa Petrella
Kerry Savage
Xinni Song
Ralph Wong
Nina Dabelić
Stjepko Plestina
Željko Vojnović
Petr Arenberger
Ivo Kocak
Ivana Krajsová
Eugen Kubala
Bohuslav Melichar
Yvetta Vantuchova
Kadri Putnik
Brigitte Dreno
Caroline Dutriaux
Jean-Jacques Grob
Pascal Joly
Jean Philippe Lacour
Nicolas Meyer
Laurent Mortier
Luc Thomas
Michael Fluck
THILO GAMBICHLER
Jessica Hassel
Axel Hauschild
Dirk Schadendorf
Paul Donnellan
John McCaffrey
Derek Power
Samuel Ariad
Gil Bar-Sela
Daniel Hendler
Ilan Ron
Jacob Schachter
Paolo Ascierto
ALFREDO BERRUTI
Luca Bianchi
Vanna Chiarion Sileni
Francesco Cognetti
Riccardo Danielli
Anna Maria Di Giacomo
Luca Gianni
Aron Goldhirsch
Michele Guida
Michele Maio
Mario Mandalá
Paolo Marchetti
Paola Queirolo
Armando Santoro
Ellen Kapiteijn
Andrzej Mackiewicz
Piotr Rutkowski
Paula Ferreira
Lev Demidov
Georgy Gafton
Yulia Makarova
Zoran Andric
Nada Babović
Darjana Jovanovic
Lidija Kandolf Sekulovic
Graham Cohen
Lydia Dreosti
Daniel Vorobiof
Maria Teresa Curiel Garcia
Roberto Díaz-Beveridge
Margarita Majem Tarruella
Ivan Marquez-Rodas
Jose M Puliats Rodriguez
Antonio Rueda Dominguez
Marianne Maroti
Karin Papworth
Olivier Michielin
Igor Bondarenko
Ewan Brown
Pippa Corrie
Mark Harries
Christopher Herbert
Satish Kumar
Agustín Martín Clavijo
Mark Middleton
Poulam Patel
Toby Talbot
Sanjiv Agarwala
Paul Chapman
Robert Conry
Gary Doolittle
Tara Gangadhar
Sigrun Hallmeyer
Omid Hamid
Leonel Hernandez-Aya
Douglas Johnson
Frederic Kass
Tatjana Kolevska
Karl Lewis
Scott Lunin
April Salama
Branimir Sikic
Bradley Somer
David Spigel
Eric Whitman
Publication typeJournal Article
Publication date2018-04-01
scimago Q1
wos Q1
SJR11.319
CiteScore50.8
Impact factor35.9
ISSN14702045, 14745488
Oncology
Abstract
Systemic adjuvant treatment might mitigate the high risk of disease recurrence in patients with resected stage IIC-III melanoma. The BRIM8 study evaluated adjuvant vemurafenib monotherapy in patients with resected, BRAFV600 mutation-positive melanoma.BRIM8 was a phase 3, international, double-blind, randomised, placebo-controlled study that enrolled 498 adults (aged ≥18 years) with histologically confirmed stage IIC-IIIA-IIIB (cohort 1) or stage IIIC (cohort 2) BRAFV600 mutation-positive melanoma that was fully resected. Patients were randomly assigned (1:1) by an interactive voice or web response system to receive twice-daily adjuvant oral vemurafenib 960 mg tablets or matching placebo for 52 weeks (13 × 28-day cycles). Randomisation was done by permuted blocks (block size 6) and was stratified by pathological stage and region in cohort 1 and by region in cohort 2. The investigators, patients, and sponsor were masked to treatment assignment. The primary endpoint was disease-free survival in the intention-to-treat population, evaluated separately in each cohort. Hierarchical analysis of cohort 2 before cohort 1 was prespecified. This trial is registered with ClinicalTrials.gov, number NCT01667419.The study enrolled 184 patients in cohort 2 (93 were assigned to vemurafenib and 91 to placebo) and 314 patients in cohort 1 (157 were assigned to vemurafenib and 157 to placebo). At the time of data cutoff (April 17, 2017), median study follow-up was 33·5 months (IQR 25·9-41·6) in cohort 2 and 30·8 months (25·5-40·7) in cohort 1. In cohort 2 (patients with stage IIIC disease), median disease-free survival was 23·1 months (95% CI 18·6-26·5) in the vemurafenib group versus 15·4 months (11·1-35·9) in the placebo group (hazard ratio [HR] 0·80, 95% CI 0·54-1·18; log-rank p=0·26). In cohort 1 (patients with stage IIC-IIIA-IIIB disease) median disease-free survival was not reached (95% CI not estimable) in the vemurafenib group versus 36·9 months (21·4-not estimable) in the placebo group (HR 0·54 [95% CI 0·37-0·78]; log-rank p=0·0010); however, the result was not significant because of the prespecified hierarchical prerequisite for the primary disease-free survival analysis of cohort 2 to show a significant disease-free survival benefit. Grade 3-4 adverse events occurred in 141 (57%) of 247 patients in the vemurafenib group and 37 (15%) of 247 patients in the placebo group. The most common grade 3-4 adverse events in the vemurafenib group were keratoacanthoma (24 [10%] of 247 patients), arthralgia (17 [7%]), squamous cell carcinoma (17 [7%]), rash (14 [6%]), and elevated alanine aminotransferase (14 [6%]), although all keratoacanthoma events and most squamous cell carcinoma events were by default graded as grade 3. In the placebo group, grade 3-4 adverse events did not exceed 2% for any of the reported terms. Serious adverse events were reported in 40 (16%) of 247 patients in the vemurafenib group and 25 (10%) of 247 patients in the placebo group. The most common serious adverse event was basal cell carcinoma, which was reported in eight (3%) patients in each group. One patient in the vemurafenib group of cohort 2 died 2 months after admission to hospital for grade 3 hypertension; however, this death was not considered to be related to the study drug.The primary endpoint of disease-free survival was not met in cohort 2, and therefore the analysis of cohort 1 showing a numerical benefit in disease-free survival with vemurafenib versus placebo in patients with resected stage IIC-IIIA-IIIB BRAFV600 mutation-positive melanoma must be considered exploratory only. 1 year of adjuvant vemurafenib was well tolerated, but might not be an optimal treatment regimen in this patient population.F Hoffman-La Roche Ltd.
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Ascierto P. A. et al. Adjuvant vemurafenib in resected, BRAFV600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial // The Lancet Oncology. 2018. Vol. 19. No. 4. pp. 510-520.
GOST all authors (up to 50) Copy
Ascierto P. A. et al. Adjuvant vemurafenib in resected, BRAFV600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial // The Lancet Oncology. 2018. Vol. 19. No. 4. pp. 510-520.
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BibTex (up to 50 authors) Copy
@article{2018_Ascierto,
author = {Paolo A. Ascierto and Grant R. Goodman and Brian Simmons and Chenglin Ye and Yibing Yan and Gabriela Cinat and Luis Enrique Fein and Michael Brown and Alexander Guminski and Andrew Haydon and Adnan Khattak and Catriona McNeil and Phillip Parente and Jeremy Power and Rachel Roberts-Thomson and Shahneen Sandhu and Craig Underhill and Suresh Varma and Thomas Berger and Ahmad Awada and Nathalie Blockx and Véronique Buyse and Jeroen Mebis and Fabio Andre Franke and Sergio Jobim De Azevedo and Nicolas Silva Lazaretti and Rahima Jamal and Catalin Mihalcioiu and Teresa Petrella and Kerry Savage and Xinni Song and Ralph Wong and Nina Dabelić and Stjepko Plestina and Željko Vojnović and Petr Arenberger and Ivo Kocak and Ivana Krajsová and Eugen Kubala and Bohuslav Melichar and Yvetta Vantuchova and Kadri Putnik and Brigitte Dreno and Caroline Dutriaux and Jean-Jacques Grob and Pascal Joly and Jean Philippe Lacour and Nicolas Meyer and Laurent Mortier and Luc Thomas and others},
title = {Adjuvant vemurafenib in resected, BRAFV600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial},
journal = {The Lancet Oncology},
year = {2018},
volume = {19},
publisher = {Elsevier},
month = {apr},
url = {https://doi.org/10.1016/s1470-2045(18)30106-2},
number = {4},
pages = {510--520},
doi = {10.1016/s1470-2045(18)30106-2}
}
MLA
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MLA Copy
Ascierto, Paolo A., et al. “Adjuvant vemurafenib in resected, BRAFV600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial.” The Lancet Oncology, vol. 19, no. 4, Apr. 2018, pp. 510-520. https://doi.org/10.1016/s1470-2045(18)30106-2.