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Dabrafenib Plus Trametinib vs Vemurafenib Alone in Unresectable or Metastatic BRAF V600E/K Cutaneous Melanoma

A Phase III, Randomised, Open-label Study Comparing the Combination of the BRAF Inhibitor, Dabrafenib and the MEK Inhibitor, Trametinib to the BRAF Inhibitor Vemurafenib in Subjects With Unresectable (Stage IIIc) or Metastatic (Stage IV) BRAF V600E/K Mutation Positive Cutaneous Melanoma

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01597908
Acronym
COMBI-v
Enrollment
704
Registered
2012-05-14
Start date
2012-06-04
Completion date
2019-04-25
Last updated
2021-02-24

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Melanoma

Keywords

BRAF inhibitor, Metastatic Melanoma, Cancer, MEK inhibitor

Brief summary

This was a two-arm, open-label, randomized, Phase III study comparing dabrafenib (GSK2118436) and trametinib (GSK1120212) combination therapy with vemurafenib.

Detailed description

Screening/Subject eligibility: Subjects with histologically confirmed cutaneous melanoma that was either unresectable or metastatic (Stages IIIC or IV), were screened for eligibility. Eligible subjects were BRAF V600E or V600K mutation positive. Subjects who had prior systemic anti-cancer treatment in the advanced or metastatic setting were not eligible although prior systemic treatment in the adjuvant setting was allowed. Randomization: A total of 704 subjects were randomized in a ratio of 1:1 to receive combination therapy (352 subjects) or vemurafenib treatment (352 subjects). Subjects were stratified by LDH level (\> the ULN versus =\< ULN) and BRAF mutation (V600E versus V600K). Study treatment: Dabrafenib and trametinib were administered orally at their recommended doses of 150 mg b.i.d. and 2.0 mg once daily, respectively. Subjects randomized in the combination therapy arm received both the agents. Subjects randomized in the vemurafenib arm received vemurafenib at the recommended dose of 960 mg orally b.i.d. Subjects in both the arms continued treatment until disease progression, death, unacceptable toxicity, or withdrawal of consent. The protocol was amended on 07-Aug-2014 which allowed subjects who were still receiving vemurafenib to cross over to the dabrafenib and trametinib combination arm, including those subjects who were still receiving vemurafenib monotherapy treatment after disease progression. A washout period of a minimum of 7 days was considered prior to initiating dabrafenib in combination with trametinib. Subjects who experienced disease progression on the vemurafenib monotherapy arm, discontinued vemurafenib monotherapy, and subsequently received another anticancer therapy were ineligible for cross over to the dabrafenib and trametinib combination arm. Follow-up/Study closure: After study treatment discontinuation, subjects were followed for survival and disease progression as applicable. This study completed once all the subjects had at least the 5-years of follow-up.

Interventions

DRUGDabrafenib

Dabrafenib 150 mg twice daily orally

DRUGVemurafenib

Vemurafenib 960 mg twice daily orally

DRUGTrametinib

Trametinib 2 mg once daily orally

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Key Inclusion Criteria: * \>= 18 years of age * Stage IIIc or Stage IV BRAF V600E/K cutaneous melanoma * Measurable disease according to RECIST 1.1 * Women of childbearing potential with negative serum pregnancy test prior to randomisation * Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1 * Adequate baseline organ function Key

Exclusion criteria

* Any prior use of a BRAF or MEK inhibitor * Prior systemic anti-cancer treatment in the advanced or metastatic setting; prior systemic treatment in the adjuvant setting is allowed * History of another malignancy (except subjects who have been disease free for 3 years or with a history of completely resected non-melanoma skin cancer) * Known HIV, HBV, HCV infection (except chronic or cleared HBV and HCV infection which will be allowed) * Brain metastases (except if all known lesions were previously treated with surgery or stereotactic radiosurgery and lesions, if still present, are confirmed stable for \>= 12 weeks prior to randomisation or if no longer present are confirmed no evidence of disease for \>= 12 weeks, and are asymptomatic with no corticosteroid requirements for \>= 4 weeks prior to randomisation, and no enzyme inducing anticonvulsants for \>= 4 weeks prior to randomisation * History or evidence of cardiovascular risk (LVEF \< LLN; QTcB \>= 480 msec; blood pressure or systolic \>=140 mmHg or diastolic \>= 90 mmHg which cannot be controlled by anti-hypertensive therapy) * History or current evidence/risk of retinal vein occlusion (RVO) or central serous retinopathy (CSR)

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS)From the date of randomization until date of death due to any cause (up to approximately 6 years)Overall Survival (OS) was defined as the interval of time between the date of randomization and the date of death due to any cause. For patients who did not die, OS was censored at the date of last contact.

Secondary

MeasureTime frameDescription
Progression-Free Survival (PFS), as Assessed by the InvestigatorFrom randomization until the earliest date of disease progression (PD) or death due to any cause (up to approximately 6 years)Progression-free survival (PFS) was defined as the interval of time between the date of randomization and the first documented occurrence of disease progression or death due to any cause. PFS for investigator-assessed response was summarized per Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1, which is a set of published rules defining when cancer patients improve (respond), stay the same (stabilize), or worsen (progress) during treatment. Disease progression was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 millimeters (mm) or the appearance of at least 1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation.
Overall Response Rate (ORR) During Randomized Phase, as Assessed by the InvestigatorFrom randomization until the first documented complete response or partial response (up to approximately 6 years)Overall response was defined as the percentage of confirmed responders (complete response \[CR\] + partial response \[PR\] per RECIST, Version 1.1) as summarized by Investigator assessment. CR was defined as the disappearance of all evidence of target lesions. PR was defined as at least a 30% reduction from Baseline in the sum of the longest diameter (LD) of all target lesions. Data were reported as those participants with measureable disease at Baseline.
Duration of Response (DOR), as Assessed by the InvestigatorFrom the time of the first documented response (CR or PR) until disease progression (up to approximately 6 years)Duration of Response (DOR) was defined as the time from the first documented evidence of a CR (disappearance of all evidence of target lesions) or a PR (at least a 30% reduction from Baseline in the sum of the longest diameter of all target lesions) until disease progression or death due to any cause. PD was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 mm or the appearance of at least1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation. Data were summarized per RECIST, Version 1.1.

Countries

Argentina, Australia, Austria, Belgium, Brazil, Canada, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Israel, Italy, Netherlands, New Zealand, Norway, Poland, Russia, South Korea, Spain, Sweden, Switzerland, Taiwan, Ukraine, United Kingdom, United States

Participant flow

Recruitment details

This study was conducted at 207 centers in 28 countries worldwide (Argentina, Australia, Austria, Belgium, Brazil, Canada, Czech Republic, Denmark, Finland, France, Germany, Hungary, Ireland, Israel, Italy, South Korea, Netherlands, New Zealand, Norway, Poland, Russian Federation, Spain, Sweden,Switzerland, Taiwan, Ukraine, UK and USA).

Pre-assignment details

694 subjects were planned and 704 subjects (352 each in combination therapy arm and vemurafenib monotherapy arm) were actually randomized and analyzed. Subjects were stratified by LDH level (\> the ULN versus ≤ ULN) and BRAF mutation (V600E versus V600K).

Participants by arm

ArmCount
Dabrafenib Plus Trametinib
Dabrafenib 150 milligrams (mg) orally twice daily (BID) and Trametinib 2 mg orally once daily until disease progression, death, unacceptable toxicity, or withdrawal of consent.
352
Vemurafenib
Vemurafenib 960 mg orally BID until disease progression, death, unacceptable toxicity, or withdrawal of consent.
352
Total704

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Crossover PhaseDeath0011
Crossover PhaseSponsor Decision0020
Crossover PhaseWithdrawal by Subject003
Randomized PhaseCrossover to Dabrafenib&Trametinib0340
Randomized PhaseDeath2172380
Randomized PhaseLost to Follow-up9160
Randomized PhasePhysician Decision630
Randomized PhaseSponsor Decision93390
Randomized PhaseWithdrawal by Subject26220

Baseline characteristics

CharacteristicVemurafenibTotalDabrafenib Plus Trametinib
Age, Continuous54.3 Years
STANDARD_DEVIATION 14.06
54.2 Years
STANDARD_DEVIATION 13.94
54.1 Years
STANDARD_DEVIATION 13.83
Race/Ethnicity, Customized
African American/African Heritage
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
American Indian or Alaskan Native
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
Asian - East Asian Heritage
8 Participants16 Participants8 Participants
Race/Ethnicity, Customized
Mixed Race
1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
White - Arabic/North African Heritage
2 Participants6 Participants4 Participants
Race/Ethnicity, Customized
White - Mixed Race
0 Participants1 Participants1 Participants
Race/Ethnicity, Customized
White - White/Caucasian/European Heritage
339 Participants678 Participants339 Participants
Sex: Female, Male
Female
172 Participants316 Participants144 Participants
Sex: Female, Male
Male
180 Participants388 Participants208 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
216 / 350238 / 34911 / 34465 / 699
other
Total, other adverse events
338 / 350341 / 34932 / 34679 / 699
serious
Total, serious adverse events
172 / 350139 / 34915 / 34319 / 699

Outcome results

Primary

Overall Survival (OS)

Overall Survival (OS) was defined as the interval of time between the date of randomization and the date of death due to any cause. For patients who did not die, OS was censored at the date of last contact.

Time frame: From the date of randomization until date of death due to any cause (up to approximately 6 years)

Population: Intent-to-Treat (ITT) Population.

ArmMeasureValue (MEDIAN)
Dabrafenib Plus TrametinibOverall Survival (OS)26.0 Months
VemurafenibOverall Survival (OS)17.8 Months
95% CI: [0.58, 0.83]
Secondary

Duration of Response (DOR), as Assessed by the Investigator

Duration of Response (DOR) was defined as the time from the first documented evidence of a CR (disappearance of all evidence of target lesions) or a PR (at least a 30% reduction from Baseline in the sum of the longest diameter of all target lesions) until disease progression or death due to any cause. PD was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 mm or the appearance of at least1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation. Data were summarized per RECIST, Version 1.1.

Time frame: From the time of the first documented response (CR or PR) until disease progression (up to approximately 6 years)

Population: Intent-to-Treat (ITT) Population. Only participants with confirmed response by RECIST version 1.1 were included.

ArmMeasureValue (MEDIAN)
Dabrafenib Plus TrametinibDuration of Response (DOR), as Assessed by the Investigator13.8 Months
VemurafenibDuration of Response (DOR), as Assessed by the Investigator8.5 Months
95% CI: [0.51, 0.81]
Secondary

Overall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator

Overall response was defined as the percentage of confirmed responders (complete response \[CR\] + partial response \[PR\] per RECIST, Version 1.1) as summarized by Investigator assessment. CR was defined as the disappearance of all evidence of target lesions. PR was defined as at least a 30% reduction from Baseline in the sum of the longest diameter (LD) of all target lesions. Data were reported as those participants with measureable disease at Baseline.

Time frame: From randomization until the first documented complete response or partial response (up to approximately 6 years)

Population: Intent-to-Treat (ITT) Population. Only participants with measurable disease at baseline were included.

ArmMeasureValue (NUMBER)
Dabrafenib Plus TrametinibOverall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator68 Percentage of Participants
VemurafenibOverall Response Rate (ORR) During Randomized Phase, as Assessed by the Investigator53 Percentage of Participants
Secondary

Progression-Free Survival (PFS), as Assessed by the Investigator

Progression-free survival (PFS) was defined as the interval of time between the date of randomization and the first documented occurrence of disease progression or death due to any cause. PFS for investigator-assessed response was summarized per Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1, which is a set of published rules defining when cancer patients improve (respond), stay the same (stabilize), or worsen (progress) during treatment. Disease progression was defined as at least a 20% increase in the sum of the diameters of target lesions with an absolute increase of at least 5 millimeters (mm) or the appearance of at least 1 new lesion, or the worsening of non-target lesions significant enough to require study treatment discontinuation.

Time frame: From randomization until the earliest date of disease progression (PD) or death due to any cause (up to approximately 6 years)

Population: Intent-to-Treat (ITT) Population.

ArmMeasureValue (MEDIAN)
Dabrafenib Plus TrametinibProgression-Free Survival (PFS), as Assessed by the Investigator12.1 Months
VemurafenibProgression-Free Survival (PFS), as Assessed by the Investigator7.3 Months
95% CI: [0.52, 0.73]
Post Hoc

All Collected Deaths

Pre-treatment deaths were collected from screening visit up to the first day of treatment, for a maximum duration of 28 days. Patients who died during the screening period are considered as screen failure. On treatment deaths were collected from FPFT up to 30 days after study drug discontinuation, for a maximum duration of 81.1 months (treatment duration ranged from 0.1 to 80.1 months). Deaths post treatment survival follow up were collected after the on- treatment period, up to approximately 6 years. Patients who didn't die during the on-treatment period and had not stopped study participation at the time of data cut-off (end of study) were censored.

Time frame: up to 28 days before Day 1 (Screening), up to 81.1 months (on-treatment), up to approximately 6 years (study duration)

Population: Clinical database population; all treated patients and patients who died during screening.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Dabrafenib Plus TrametinibAll Collected DeathsPre-treatment deaths1 Participants
Dabrafenib Plus TrametinibAll Collected DeathsOn-treatment deaths44 Participants
Dabrafenib Plus TrametinibAll Collected DeathsPost-treatment deaths172 Participants
Dabrafenib Plus TrametinibAll Collected DeathsAll deaths216 Participants
VemurafenibAll Collected DeathsAll deaths238 Participants
VemurafenibAll Collected DeathsPre-treatment deaths0 Participants
VemurafenibAll Collected DeathsPost-treatment deaths191 Participants
VemurafenibAll Collected DeathsOn-treatment deaths47 Participants
Crossover Dabrafenib + TrametinibAll Collected DeathsAll deaths11 Participants
Crossover Dabrafenib + TrametinibAll Collected DeathsOn-treatment deaths2 Participants
Crossover Dabrafenib + TrametinibAll Collected DeathsPost-treatment deaths9 Participants
Crossover Dabrafenib + TrametinibAll Collected DeathsPre-treatment deaths0 Participants

Source: ClinicalTrials.gov · Data processed: Mar 15, 2026