Dr Eroglu on the Role of Triplet vs Doublet Regimens in Melanoma With Symptomatic Brain Metastases

“Within the triplet arm, there were patients who had to undergo either dose holds or reductions, which we were able to [treat] with targeted therapies and sometimes with immunotherapy. In some cases, the immunotherapy agent had to be held for several cycles for a certain [AE] to resolve.”

Zeynep Eroglu, MD, a medical oncologist in the Department of Cutaneous Oncology at Moffitt Cancer Center and an assistant professor in the Department of Oncologic Sciences at the University of South Florida Morsani College of Medicine, discussed the clinical implications of using triplet vs doublet regimens for the treatment of patients with melanoma and symptomatic brain metastases.

Treating patients with symptomatic melanoma with brain metastases can be difficult and requires a multidisciplinary approach, Eroglu began. When patients present with symptomatic brain metastases, neurosurgeons are also involved if patients require surgery, as well as radiation oncologists if patients require stereotactic radiation, she explained. Of note, if patients have BRAF-mutated melanoma, the use of a triplet regimen comprised of encorafenib (Braftovi) plus binimetinib (Mektovi) and nivolumab (Opdivo) could be more therapeutically beneficial compared with nivolumab plus ipilimumab (Yervoy) in the phase 2 SWOG S2000 study (NCT04511013).

Furthermore, within the triplet arm, some patients were required to undergo dose holds or dose reductions, Eroglu noted. This was made possible with targeted therapy drugs and sometimes with immunotherapy, she continued. However, the immunotherapy was held for several cycles in some patients because of an adverse effect, which needed to be resolved before proceeding, she emphasized. Additionally, in the doublet arm, doses of nivolumab plus ipilimumab were required to be held, and in some cases, the dose of ipilimumab needed to be dropped early, in which patients would receive nivolumab alone. Notably, with immunotherapy, dose reductions were not possible because dose levels were set, according to Eroglu. Therefore, some patients underwent dose holds or discontinued treatment early if it was not safe enough to rechallenge with immunotherapy, she concluded.