Dr Mok on Choosing Between First-Line Therapies for BRAF-Mutant NSCLC

“Starting with the 2 targeted therapy [options], we have dabrafenib and trametinib. [The other combination] is encorafenib plus binimetinib. Both are similar, in a way. They’re from different companies, [and are] slightly different compounds molecularly; however, they actually [demonstrate] similar inhibition and clinical efficacy [outcomes]."

Tony S.K. Mok, BMSc, MD, FRCP(C), FHKCP, FHKAM, FASCO, chairman of the Department of Clinical Oncology and the Li Shu Fan Professor of Clinical Oncology at The Chinese University of Hong Kong, discussed the available frontline treatment options for patients with BRAF-mutant non–small cell lung cancer (NSCLC), his approach to treatment decision-making for this patient population, and what the future may hold in terms of therapeutic developments.

There are 3 primary options for patients with BRAF-mutant NSCLC, Mok began. Two involve targeted therapy—specifically TKIs—and the third is the standard approach of immunotherapy combined with chemotherapy, he said.

Targeted therapy options include the combination of dabrafenib (Tafinlar) and trametinib (Mekinist), as well as encorafenib (Braftovi) plus binimetinib (Mektovi). These regimens are mechanistically similar to each other, though the individual drugs are produced by different manufacturers and exhibit slight molecular differences, according to Mok. Despite this, both combinations have been shown to produce comparable levels of pathway inhibition and demonstrate similar clinical efficacy, he noted.

Alternatively, there is growing interest in the combination of chemotherapy and immunotherapy for patients with BRAF-mutant disease, Mok emphasized. However, current data regarding the efficacy of chemoimmunotherapy in patients with BRAF V600E mutations are limited and have not demonstrated convincing progression-free survival outcomes with this approach compared with standard targeted therapy regimens, he explained. In light of the available evidence, Mok concluded by sharing that his current preference is to use 1 of the 2 targeted therapy combinations in this patient population.