Assessing Patient Risk, Benefit, and Outcomes in Drug Development: A Decade of Dabrafenib and Trametinib Clinical Trials.

Abstract

Dabrafenib and trametinib (D&T) received accelerated approval by the FDA in 2022 for the treatment of metastatic solid tumors harboring BRAF mutations. Our aim was to evaluate the risk/benefit profile of D&T in clinical trials. A comprehensive literature search was conducted to identify relevant clinical trial publications involving D&T in adult malignancies. Trials utilizing D&T measuring responses with RECIST or other criteria were included. Data screening and extraction were performed in a masked, duplicate fashion, focusing on adverse events and primary end-points. Dabrafenib and trametinib were evaluated in many BRAF V600-mutated cancers. The median PFS across all trials was 4.5 months and the median OS was 11.5 months. However, 34% of trials did not report or reach their PFS end-point, and 54% did not report or obtain an OS value. Cumulative ORR remained consistent at around 30% throughout drug development, but the cumulative incidence of grade 3-5 AEs increased from 25% to 50% as off-label indications were studied. We found the studies that led to the accelerated approval of D&T's use in indications outside its original label to be deficient in reporting AE and outcomes. The accelerated approval filled a space needed for the treatment of other BRAF V600 malignancies that did not have a standard method of treatment. However, it is still imperative that clinical trial data be empirically driven and transparent. This encourages quality research which lays the foundation for clinical decision making that impacts patient quality of life and outcome.