FDA Approves Targeted Therapy Combo for Lung Cancer Treatment

On 6/22/17, the US Food and Drug Administration (FDA) granted full approvals to two targeted therapies to be used in combination for patients with metastatic non-small cell lung cancer (NSCLC) with BRAF V600E mutation as detected by an FDA-approved test. The two newly-approved targeted therapies, Tafinlar (dabrafenib) and Mekinist (trametinib), are both from Novartis Pharmaceuticals. These are the first FDA approvals specifically for the treatment of patients with BRAF V600E-positive metastatic NSCLC. The FDA also approved a new test, Oncomine Dx Target Test, from ThermoFisher Scientific, that can detect gene mutations (including BRAF, ROS1, and EGFR) with a single tissue simple.1

“The approval of Tafinlar + Mekinist makes BRAF V600E the fourth actionable genomic biomarker in metastatic NSCLC – along with EGFR, ALK and ROS-1… This is an important milestone for the lung cancer community as we are continuing to better understand the genomic drivers of cancer and develop effective treatments targeted for these biomarkers,” said Bruce Johnson, MD, Professor of Medicine, Chief Clinical Research Officer, Dana-Farber Cancer Institute and Harvard Medical School at Dana-Farber Cancer Institute.2

Clinical Trial Results

The approvals of Tafinlar and Mekinist, which are currently approved for advanced melanoma, were based on Study BRF113928. This study was a non-randomized, non-comparative, open label trial for patients with metastatic NSCLC and confirmed BRAF V600E mutation. Among patients who had not previously received treatment, the combination treatment resulted in an overall response rate (ORR), or the proportion of patients with reduced tumor size, of 61%. Among those patients having received lung cancer treatment prior to the study, the combination therapy resulted in a 63% ORR. Patients who received the combination of Tafinlar and Mekinist had a better response rate than those who only received Tafinlar (ORR=27%).3

The most common side effects experienced were fever, fatigue, nausea, vomiting, diarrhea, dry skin, decreased appetite, edema (swelling from excess fluid), rash, chills, bleeding, cough, and trouble breathing.3

What Is the BRAF Mutation?

All cells have coded instructions in their genes. When changes occur to the genes, the cells change their normal behavior and can become cancer cells. Each cancer is unique and has different genetic changes. As cancers grow, additional genetic changes can occur. Scientists have found that there are certain changes, or mutations, that commonly occur in many types of cancers, including lung cancer. These mutations are often a target for potential treatments to stop the cancer. In NSCLC, researchers have identified several genetic mutations that are known to play an important role in the development and progression of the lung cancer.4,5 Mutations on the BRAF gene have been found in 1-4% of all NSCLC and most often occurs in adenocarcinomas.6

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