6533b7d2fe1ef96bd125eafe

RESEARCH PRODUCT

Differential influence of vemurafenib and dabrafenib on patient lymphocytes despite similar clinical efficacy in melanoma

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Background: Since the majority of melanomas eventually become resistant and progress, combining selective BRAF inhibitors (BRAFi) with immunotherapies has been proposed to achieve more durable treatment responses. Here, we explored the impact of selective BRAFi on the hosts’ immune system. Patients and methods: Clinical data, whole blood counts (WBC) and serum lactate dehydrogenase (LDH) of 277 vemurafenib- and 65 dabrafenib-treated melanoma patients were evaluated. The frequency and phenotype of lymphocyte subpopulations were determined by flow cytometry while T cell cytokine secretion was measured by multiplex assays. Results: Progression-free survival (PFS) as well as overall survival (OS) were similar in patients treated with either BRAFi. High pretreatment LDH was associated with shorter PFS and OS in both groups. During therapy, peripheral lymphocytes decreased by 24.3% (median, P< 0.0001) in vemurafenib-treated patients but remained unchanged in dabrafenibtreated patients (+1.2%, P = 0.717). Differentiation of peripheral lymphocytes of vemurafenib-treated patients showed a significant decrease in CD4 + T cells (P< 0.05). Within CD4 + T cells obtained during treatment, an increase in CCR7 + CD45RA + (naive) and a decrease in CCR7 + CD45RA − (central memory) populations were found (P < 0.01 for both). Furthermore, secretion of interferon-γ and interleukin-9 by CD4 + T cells was significantly lower in samples obtained during vemurafenib treatment compared with baseline samples. Conclusion: While both compounds have comparable clinical efficacy, vemurafenib but not dabrafenib decreases patients peripheral lymphocyte counts and alters CD4 + T cell phenotype and function. Thus, selective BRAFi can signifi