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Translational Cancer Mechanisms and Therapy

Distinct Molecular Profiles and Immunotherapy Treatment Outcomes of V600E and V600K BRAF-Mutant Melanoma

Inês Pires da Silva, Kevin Y.X. Wang, James S. Wilmott, Jeff Holst, Matteo S. Carlino, John J. Park, Camelia Quek, Matthew Wongchenko, Yibing Yan, Graham Mann, Douglas B. Johnson, Jennifer L. McQuade, Rajat Rai, Richard F. Kefford, Helen Rizos, Richard A. Scolyer, Jean Y.H. Yang, Georgina V. Long and Alexander M. Menzies
Inês Pires da Silva
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
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Kevin Y.X. Wang
2School of Mathematics and Statistics, The University of Sydney, Sydney, New South Wales, Australia.
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  • ORCID record for Kevin Y.X. Wang
James S. Wilmott
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
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  • ORCID record for James S. Wilmott
Jeff Holst
3School of Medical Sciences and Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
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Matteo S. Carlino
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
4Crown Princess Mary Cancer Centre Westmead Hospital, Westmead, New South Wales, Australia.
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John J. Park
5Departments of Biomedical Sciences and Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
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Camelia Quek
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
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Matthew Wongchenko
6Genentech, Inc., South San Francisco, California.
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Yibing Yan
6Genentech, Inc., South San Francisco, California.
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Graham Mann
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
7Westmead Institute for Medical Research, University of Sydney, New South Wales, Australia.
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Douglas B. Johnson
8Vanderbilt University Medical Center, Nashville, Tennessee.
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Jennifer L. McQuade
9The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Rajat Rai
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
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Richard F. Kefford
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
4Crown Princess Mary Cancer Centre Westmead Hospital, Westmead, New South Wales, Australia.
5Departments of Biomedical Sciences and Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
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Helen Rizos
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
5Departments of Biomedical Sciences and Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
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Richard A. Scolyer
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
10Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Jean Y.H. Yang
2School of Mathematics and Statistics, The University of Sydney, Sydney, New South Wales, Australia.
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Georgina V. Long
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
11Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia.
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Alexander M. Menzies
1Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
11Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia.
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  • For correspondence: alexander.menzies@sydney.edu.au
DOI: 10.1158/1078-0432.CCR-18-1680 Published February 2019
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  • Figure 1.
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    Figure 1.

    Clinical outcomes after treatment with BRAFi±MEKi in V600E (red) and V600K (blue) metastatic melanoma. A, Best change in RECIST target lesions (%). B, PFS. C, OS.

  • Figure 2.
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    Figure 2.

    Differences in gene expression between V600E and V600K melanoma. A, Differentially expressed genes (Nanostring data from BRAFi±MEKi cohort). Unadjusted P values: ⇐0.05 (light turquoise blue) and >0.05 (dark cadet blue). The top 10 differentially expressed genes are labeled (navy blue). B, Validation of increased DUSP6 expression in V600E melanomas (TCGA data). DESeq2 P value: 1.329e−05. DESeq2 adj. P value: 0.002843. Each dot/triangle represents one single sample.

  • Figure 3.
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    Figure 3.

    Mutational load in V600E (red) and V600K (blue) melanoma. NGS data from BRAFi±MEKi cohort (A) and TCGA (B) data. Each dot/triangle represents one single sample.

  • Figure 4.
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    Figure 4.

    Clinical outcomes after treatment with anti–PD-1 immunotherapy in V600E (red) and V600K (blue) metastatic melanoma. A, Best change in RECIST targets (%). B, PFS. C, OS.

Tables

  • Figures
  • Table 1.

    Baseline characteristics of patients with V600E versus V600K metastatic melanoma (BRAFi±MEKi cohort)

    CharacteristicsV600E (n = 78)V600K (n = 15)P value
    Age (years)
     Median56.558.00.418
    Gender (N, %)0.5786
     Female33 (42%)5 (33%)
     Male45 (58%)10 (67%)
    AJCC stagea (N, %)1
     IIIC–M1b19 (24%)3 (20%)
     M1c59 (76%)12 (80%)
    LDH (N, %)0.3563
     Normal57 (73%)9 (60%)
     Elevated21 (27%)6 (40%)
    ECOG (N, %)1
     047 (60%)9 (60%)
     ≥131 (40%)6 (40%)
    Treatment (N, %)0.3162
     BRAFi62 (80%)10 (67%)
     BRAFi + MEKi16 (20%)5 (33%)
    • ↵aAJCC v7 anatomic staging, excluding LDH and brain metastases.

  • Table 2.

    Baseline characteristics of patients with V600E versus V600K metastatic melanoma (immunotherapy cohort)

    CharacteristicsV600E (n = 84)V600K (n = 19)P value
    Age (years)
     Median5161.50.0358
    Gender (N, %)0.001
     Female41 (49%)3 (16%)
     Male43 (51%)16 (84%)
    AJCC stagea (N, %)0.7571
     IIIC–M1b18 (21%)3 (16%)
     M1c66 (79%)16 (84%)
    LDH (N, %)0.1195
     Normal49 (58%)15 (79%)
     Elevated35 (42%)4 (21%)
    ECOG (N, %)0.2037
     042 (50%)13 (68%)
     ≥142 (50%)6 (32%)
    Prior MAPKi (N, %)0.8042
     No47 (56%)11 (58%)
     Yes37 (44%)8 (42%)
    PD1 therapy (N, %)0.0229
     Nivolumab222
     Pembrolizumab6217
    • ↵aAJCC v7 anatomic staging, excluding LDH and brain metastases.

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Clinical Cancer Research: 25 (4)
February 2019
Volume 25, Issue 4
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Distinct Molecular Profiles and Immunotherapy Treatment Outcomes of V600E and V600K BRAF-Mutant Melanoma
Inês Pires da Silva, Kevin Y.X. Wang, James S. Wilmott, Jeff Holst, Matteo S. Carlino, John J. Park, Camelia Quek, Matthew Wongchenko, Yibing Yan, Graham Mann, Douglas B. Johnson, Jennifer L. McQuade, Rajat Rai, Richard F. Kefford, Helen Rizos, Richard A. Scolyer, Jean Y.H. Yang, Georgina V. Long and Alexander M. Menzies
Clin Cancer Res February 15 2019 (25) (4) 1272-1279; DOI: 10.1158/1078-0432.CCR-18-1680

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Distinct Molecular Profiles and Immunotherapy Treatment Outcomes of V600E and V600K BRAF-Mutant Melanoma
Inês Pires da Silva, Kevin Y.X. Wang, James S. Wilmott, Jeff Holst, Matteo S. Carlino, John J. Park, Camelia Quek, Matthew Wongchenko, Yibing Yan, Graham Mann, Douglas B. Johnson, Jennifer L. McQuade, Rajat Rai, Richard F. Kefford, Helen Rizos, Richard A. Scolyer, Jean Y.H. Yang, Georgina V. Long and Alexander M. Menzies
Clin Cancer Res February 15 2019 (25) (4) 1272-1279; DOI: 10.1158/1078-0432.CCR-18-1680
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