The edition · Dermatology
Adjuvant BRAF/MEK in stage IIB/IIC melanoma: a trial that ran out of patients
COLUMBUS-AD closed early with 110 of a planned 815 randomised, leaving encouraging numbers that cannot answer the question. Plus what response rate really predicts in metastatic melanoma, dermatologist supply and stage at diagnosis, post-laser barrier care, and a split-face comparison of two lasers for atrophic acne scars.
The edition in brief
EORTC 2139 (COLUMBUS-AD) randomised patients with resected stage IIB or IIC BRAF V600E/K-mutated cutaneous melanoma to a year of encorafenib and binimetinib or placebo. Accrual stopped early at 110 of a planned 815, and the primary endpoint was changed to safety, so the recurrence-free survival figures - 86% versus 70% at twelve months - are secondary, imprecise and follow arms with unequal follow-up. A third of those who started the combination discontinued for adverse events. A separate individual-patient meta-analysis of 1,865 patients in four first-line nivolumab trials tested three candidate surrogates for overall survival: objective response rate correlated strongly at the individual level but only moderately at the trial level, and time to next treatment or death performed best of the three, with all trial-level R-squared values carrying very wide intervals. An ecological study of 557 US health service areas found higher dermatologist density associated with a lower proportion of melanoma diagnosed late, with odds reduced by 11% to 20% across density bands; the design cannot show causation. A 112-day randomised trial in 88 Chinese women reported better barrier recovery and cosmetic measures with a branded post-procedure regimen after picosecond laser, but published no effect sizes. In a 27-patient split-face randomised comparison for atrophic acne scars, a 755-nm picosecond laser with a diffractive lens array and a 1565-nm nonablative fractional laser worked equally well, with the picosecond arm better tolerated and rated higher by patients.
Adjuvant encorafenib and binimetinib in stage IIB/IIC melanoma
COLUMBUS-AD closed early and cannot answer whether adjuvant encorafenib and binimetinib helps in stage IIB/IIC melanoma, but it does show a third of patients stopping for toxicity.
What response rate actually predicts in first-line melanoma immunotherapy
Response rate strongly predicts survival for an individual patient but only moderately predicts whether a trial's survival benefit will materialise, so read response-rate readouts as provisional.
Where there are more dermatologists, melanoma is found earlier
Melanoma is diagnosed later where dermatologists are scarce, which is an argument for triage and teledermatology rather than a finding about any individual patient.
Post-laser barrier care: a positive trial that reports no numbers
Use a bland barrier-repair regimen and strict photoprotection after non-ablative laser, but do not let this trial choose a branded product for you — it publishes no effect sizes.
Prescribe topical steroid by quantity, not just by potency
Specify how much topical steroid to use, in fingertip units and grams, because under-application is a commoner cause of apparent treatment failure than insufficient potency.
Two lasers, equal results for atrophic acne scars — one is easier to sit through
For atrophic acne scars, a 755-nm picosecond laser and a 1565-nm nonablative fractional laser gave equal improvement, so choose on tolerability and pigmentary risk — which favours the picosecond device in darker skin.
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