WEDNESDAY, June 11, 2025 (HealthDay News) -- For patients with stage III to IV melanoma, a second course of adjuvant treatment is feasible, but recurrence-free survival is lower with anti-programmed cell death 1 (PD-1) checkpoint inhibitors versus BRAF + MEK inhibitors, according to a study published online May 7 in the Journal of the European Academy of Dermatology and Venereology.

Katharina Schumann, Ph.D., from the Technical University of Munich in Germany, and colleagues conducted a multicenter, retrospective study examining a second course of adjuvant therapy after recurrence and surgery in patients with stage III to IV melanoma. Between January 2017 and October 2021, patients received nivolumab (NIV), pembrolizumab (PEM; both PD-1 checkpoint inhibitors), or dabrafenib plus trametinib (D + T; a BRAF inhibitor and an MEK inhibitor, respectively). Twelve-month recurrence-free survival for the second-course of adjuvant treatment (RFS2) was the primary end point.

The study included 62 patients; 32, nine, and 25 received D+T, PEM, and NIV, respectively. The researchers found that RFS2 showed superiority for adjuvant BRAF + MEK over PD-1 therapy (12-month RFS2: 90.6 versus 70.6 percent; hazard ratio, 4.226; 24-month RFS2: 71.9 versus 52.9 percent; hazard ratio, 3.154). No significant decrease was seen in overall survival with either BRAF + MEK or PD-1 treatment. Among patients with BRAF V600 mutations, RFS2 was significantly improved for those with a class switch from PD-1 to BRAF + MEK versus from BRAF + MEK to PD-1 (hazard ratio, 4.40).

"The study provides first data that a class switch of PD-1 to BRAF + MEK inhibition provides improved RFS compared to a switch from BRAF + MEK to anti-PD-1 treatment in an adjuvant setting," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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