ALEXANDRIA, Va. - Two studies from the inaugural ASCO Plenary Series session will highlight the latest practice-changing results in advanced melanoma and digital symptom monitoring. The studies will be presented in a live broadcast session on November 16, 2021, at 3:00 PM ET. View the session recording (you must log in with an asco.org username and password to access the recording).

Immunotherapy Followed by Targeted Therapy Leads to Better Overall Survival for Patients With Advanced Melanoma With BRAF Mutation

ASCO Expert Perspective 
“The study results from DREAMseq answer one of the most important clinical questions in our care of patients with advanced melanoma. For patients with melanoma with BRAFV600 mutation who have not received prior therapy, the results clearly show better overall survival when combination immunotherapy is selected first. In an era of remarkable advances for patients with melanoma, this study is an important addition to understanding the best approach to provide the very best care,” said ASCO Expert Lynn Schuchter, MD, FASCO.

For patients with advanced metastatic melanoma with BRAFV600 mutation, starting treatment with the immune checkpoint inhibitor combination of nivolumab/ipilimumab (N/I) followed by targeted therapy with dabrafenib/trametinib (D/T) resulted in greater overall survival when compared to the converse sequence. These research findings from the DREAMseq trial were presented during the inaugural session of the American Society of Clinical Oncology (ASCO) Plenary Series. These findings challenge current standards of care as many patients currently receive the targeted therapy combination first. 

According to the lead author, about 45% of patients have a melanoma with BRAF mutations. This type of melanoma is relatively more common in younger patients. In the study: 

• Eligible patients with advanced metastatic melanoma with BRAFV600 mutation who had not previously received systemic treatment were stratified by ECOG Performance Status 0 or 1 and lactate dehydrogenase (LDH) level and randomized 1:1 to receive Step 1 with either N/I (Arm A) or D/T (Arm B) and if disease progression occurred were then enrolled into Step 2 receiving the alternate therapy, D/T (Arm C) or N/I (Arm D). 
• Long-term overall survival was higher with the sequence of therapies starting with the immunotherapy combination (Arm A) followed by the targeted therapy combination (Arm C) compared to the converse sequence. 
• The two-year overall survival rate for patients starting with Arm A was 72% and for those starting with Arm B was 52%. 
• Increased overall survival was first seen after 10 months, indicating the importance of switching to targeted therapy salvage in the small percentage of patients who had rapid progression on initial N/I therapy.  
• Even though the N/I regimen has toxicities that required stopping therapy in many patients, a high percentage of patients achieved durable remissions. 

“Our findings establish definitively that even for this oncogene driven tumor that the sequence beginning with immunotherapy—rather than targeted therapy—produces better overall survival for the vast majority of patients,” said lead author Michael B. Atkins, MD. “This is practice-changing because many patients, especially in the community oncology setting, receive targeted therapy as their initial treatment.” 

From the November 2021 ASCO Plenary Series: DREAMseq (Doublet, Randomized Evaluation in Advanced Melanoma Sequencing): A phase III trial—ECOG-ACRIN EA6134, Michael B. Atkins, et al.

View Dr. Schuchter's Disclosures

Digital Symptom Monitoring Using Patient-Reported Data Helps Improve Symptom Control and Physical Function of Patients During Cancer Treatment

ASCO Expert Perspective
"These results suggest a relatively simple approach to improving how we care for patients with advanced cancer receiving treatment and a range of future applications to further improve how oncologic care is delivered,” said ASCO Expert Robert Dreicer, MD, MS, MACP, FASCO.

A digital symptom monitoring system in which patients undergoing cancer treatment report symptoms through weekly at-home surveys led to better symptom control and physical function, according to research presented during the inaugural session of the American Society of Clinical Oncology (ASCO) Plenary Series. In the study:

• A total of 52 United States-based community oncology practices were randomized 1:1 to digital symptom monitoring with patient-reported outcome (PRO) surveys or to usual care control. The study cohort included 1,191 patients with 593 patients at PRO practices and 598 patients at control practices.
• At the PRO practices, participants were invited to complete a weekly survey either by web or automated telephone system for up to one year. The survey included questions about nine common symptoms, performance status, and falls.
• Severe or worsening symptoms triggered electronic alerts to care team nurses, and reports showing symptom data over time were available to oncologists during in-person or telehealth visits.
• Enabling patients to report their symptoms and side effects directly to their cancer care team between visits led to improved communication with the team, better symptom management, and improved quality of life:
  • Compared to patients at the control practices, clinically meaningful benefits were experienced in physical function (measured by the EORTC QLQ-C30, a questionnaire assessing health status over the previous week) by 13.8% more patients at PRO practices, in symptom control (nausea/vomiting, pain, dyspnea, constipation, diarrhea, insomnia, appetite loss, fatigue) by 16.1% more patients at PRO practices, and in health-related quality of life (a combination of function and symptom scores) by 13.4% more patients at PRO practices.
• Patients completed over 91% of expected surveys. Care team nurses responded to notifications about severe or worsening symptoms 59% of the time, most commonly by calling patients at home to counsel them on symptom management, add supportive medicines, or to set up new appointments.

“This national trial provides evidence that a simple technology asking patients about their symptoms is feasible, significantly improves symptom management, and yields better clinical outcomes,” said lead author Ethan Basch, MD, MSc. “For this type of system to work, it is essential to have not only high patient participation but a strong commitment from the health care team.”

From the November 2021 ASCO Plenary Series: Digital symptom monitoring with patient-reported outcomes in community oncology practices: A U.S. national cluster randomized trial, Ethan Basch, et al.

View the Full Abstracts

View Dr. Dreicer’s Disclosures

ATTRIBUTION TO THE ASCO PLENARY SERIES IS REQUESTED IN ALL COVERAGE.

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