Rationale and background It is now accepted by the majority of experts in oncology that most
effective and safe therapy options should be considered for first-line treatment, including
adjuvant setting. As the routine administration of drugs including dosing, treatment
interruptions, and early termination in clinical practice may vary from procedures used in
clinical trials, post-authorization "real-world" data are important to quantify feasibility,
acceptance, and practical considerations on prescription of targeted therapy with
Dabrafenib+Trametinib. Therefore, it is of great interest for clinical and scientific
communities to evaluate patient and treatment choice used in routine practice of Russian
oncology centers. The aim of this study is to asses clinical outcomes of patient receiving
Dab+Tram in different substages of resectable melanoma and different lines in metastatic
melanoma., Additionally, it is of interest to gain insights into real world data regarding
quality of life of melanoma patients treated with Dabrafenib and Trametinib in adjuvant or
metastatic setting.
Research question and objectives Primary objective The primary objective in the study is to
estimate relapse-free survival (RFS) in melanoma patients in adjuvant settings and
progression free survival (PFS) in melanoma patients in metastatic settings. Primary
endpoints
• The primary efficacy endpoint of the study is 12-month RFS rate, definded as the time form
index date to the date of first documented relapse or death due to any cause.
The primary efficacy endpoint of the study is 12-month PFS rate, defined as the time from the
index date to the date of the first documented progression by investigator judgement or death
due to any cause. If a patient has not had an event, PFS will be censored at the date of the
last tumor assessment
Secondary objectives
To describe patient populations receiving dabrafenib and trametinib for stage III
resectable melanoma with respect to demographics and clinical characteristics at index
date (baseline).
To describe patient populations receiving dabrafenib and trametinib for stage IV
metastatic melanoma with respect to demographics and clinical characteristics at index
date (baseline).
Evaluate retrospectively the sequence of therapy prior to initiating treatment with
Dabrafenib and Trametinib.
Analyze prospectively treatment options following disease recurrence or progression on
treatment with Dabrafenib and Trametinib.
Analyze proportion (%) of patients receiving adjuvant therapy with Dabrafenib and
Trametinib for melanoma stage IIIA/IIIB/IIIC/IIID
Analyze proportion (%) of patients receiving Dabrafenib and Trametinib in 1L/2L/3L/later
lines in metastatic settings.
Assess clinical outcomes (including treatment duration, treatment discontinuation rate)
in melanoma patients treated with Dabrafenib and Trametinib in adjuvant settings in
real-world practice.
Assess clinical outcomes in melanoma patients treated with Dabrafenib and Trametinib in
metastatic settings (including median PFS, treatment duration, RR and) in real-world
practice.
Assess safety of therapy of interest: rate of adverse events associated with the
therapy, proportions of patients and reasons of dose adjustment on dabrafenib and
trametinib, discontinuation rate and reasons of discontinuation in melanoma patients
treated with Dabrafenib and Trametinib in adjuvant and metastatic in real-world
practice.
Describe changes in patient-reported symptoms and quality of life (QoL) in melanoma
patients treated with Dabrafenib and Trametinib in real-world setting.
Study design Patients will attend study sites in accordance with routine clinical practice.
It is assumed that visits will performed every 3-4 months, as it is stated by the current
guidelines (1). Patients will undergo standard procedures and tests according to clinical
guidelines and physician's judgement (1). Available data from routine clinical management of
the patients will be collected in the course of visits to investigation site.
The supposed duration of observation within the study is 1 year which corresponds to the
requested duration of adjuvant therapy and is in line with the median PFS - 11.1 months
according to the COMBI D/V trials' analysis for dabrafenib+trametinib therapy in the first
line treatment of metastatic cutaneous melanoma with BRAF mutation (2). The enrollment period
will continue for two years.
Baseline assessments will include collection of patient demographic data, disease history,
treatment history, laboratory data and physical examination results as assessed by clinicians
and patient reported outcomes (PROs) for symptoms and QoL. Treatment history will include all
pharmacological therapy, its duration, response duration, reason for discontinuation. QoL
assessment is not a part of routine practice for some investigation sites, hence, QoL will be
evaluated if it does not interfere routine practice.
At each following visit (as indicated above, approximately each 3-4 months up to 1 year)
available information on treatment status, response and progression, PROs, patient
performance status and any relevant adverse occurrences will be collected.
Setting and study population This study is planned as a prospective non-interventional
multicenter study. This study is observational in nature and does not impose a therapy
protocol, diagnostic/therapeutic interventions or a visit schedule. Patients with resectable
or metastatic BRAF+ melanoma, in that treatment with dabrafenib and trametinib was initiated,
either newly diagnosed or progressive during prior lines of therapy, will be included into
the study. Initiation of dabrafenib+trametinib therapy will be considered an index event.
Adult patients receiving dabrafenib and trametitnib for adjuvant or metastatic melanoma
treatment will be enrolled into study.
Variables All data will be collected in the course of prospective visits of patient to the
clinical site according to routine practice. Demographic, disease and treatment-related
variables will be collected in order to ensure completeness of data for endpoint analysis.
Definitions of variables for analysis will be given in the relevant section of protocol.
Data sources Medical records and other disease-related documents will be used in the study.
Study size This study does not test any pre-defined statistical hypotheses therefore sample
size and power calculation projections are not applicable. Since there is no formal
hypothesis-testing, sample size for this study is based on the feasibility of enrolling the
desired population during the enrolment period for this study.
Data analysis This is an exploratory study and no comparative analysis is planned.
Descriptive statistics will be tabulated for the demographic and clinical characteristics and
outcome variables. In all cases, point estimates as well as the corresponding two-sided 95%
CI will be presented. No missing value imputation will be performed.
Kaplan-Meier method will be used for the analysis of time-to-event.
Milestones
Planned dates of study milestones:
Concept approved: 29 April 2021 Final protocol approval: 30 June 2021 Start of data
collection (FPFV): 30 September 2021 End of enrollment (LPFV): 30 September 2023 End of
primary data collection (LPLV): 30 September 2024 Final report on study results: 30 April
2025 Publication of study results: 30 September 2025