I hate to say it, but we tend to start the combination that we are most familiar with – dabrafenib/trametinib. However, if someone develops side effects, we certainly think about vem/cobi.
Factors that would sway me to switch would be a better side effect profile and improved efficacy. It looks like the data for encorafenib and binimetinib will meet those qualifications so it is very exciting.
I suspect a third combination will help bring down the costs of these meds as they each look to protect or gain their market share. What a whirlwind for new drug approvals in melanoma! It is exciting and challenging all at the same time.