A study testing a new way of managing fever linked to dabrafenib and trametinib for melanoma skin cancer (COMBI-APlus)

Please note - this trial is no longer recruiting patients. We hope to add results when they are available.

Cancer type:

Skin cancer




Phase 3
This study is looking at how best to manage fever that the combination of dabrafenib and trametinib can cause. 
It is for people whose:
  • melanoma cells have a change in a gene called BRAF
  • melanoma has either grown into surrounding tissues or lymph nodes Open a glossary item and they have had surgery to remove this

More about this trial

The usual treatment for melanoma that has grown into surrounding tissue is to have surgery to remove it. There are several different treatments you might have afterwards to help prevent the cancer coming back.
For example, you might have a combination of 2 drugs called dabrafenib and trametinib. These are both a type of targeted drug called cancer growth blockers. They work in slightly different ways to stop signals that cancer cells use to divide and grow.
A high temperature (fever) is a common side effect of the combination of dabrafenib and trametinib. Sometimes the fever can be severe. And managing it might involve a hospital stay or stopping treatment.
In this study, researchers want to improve how doctors manage fever. They have developed a new system to do this and want to check how well it works. 
The main of aims of this study are to see if the new way of managing fever:
  • lowers the risk of a hospital admission
  • reduces how severe the fever is
  • reduces the number of people who permanently stop treatment because of fever

Who can enter

The following bullet points list the entry conditions for this study. Talk to your doctor or the study team if you are unsure about any of these. They will be able to advise you. 
Who can take part
You may be able to join this study if all of the following apply. 
  • have had surgery to remove melanoma that has grown into surrounding tissues (stage 3 melanoma) within 12 weeks of starting study treatment
  • have a gene change Open a glossary item in the melanoma cells called BRAFV600 with specific subtype
  • have had a heart scan that shows your heart is working well
  • can swallow and absorb tablets
  • have satisfactory blood test results
  • are well enough to carry out all your normal activities, apart from heavy physical work (performance status of 0 or 1)
  • are willing to use reliable contraception during the study and for up to 16 weeks afterwards if there is any chance you or your partner could become pregnant
  • are at least 18 years old 
Who can’t take part
You cannot join this study if any of these apply. 
Cancer related 
  • have melanoma of the eye or mucosal melanoma which is a rare type of melanoma that starts in the moist tissue (mucosa) which lines the mouth, nose, food pipe, anus, vulva and vagina
  • have melanoma that has spread to another part of the body
  • have already had treatment after or before surgery such as chemotherapy, a targeted drug Open a glossary item, vaccines Open a glossary item, experimental drugs or radiotherapy
  • have had an experimental drug in the last 28 days or it hasn’t cleared your body yet 
  • have had any other cancer in the last 2 years apart from basal cell skin cancer Open a glossary item, squamous cell skin cancer Open a glossary item, or carcinoma insitu (CIS Open a glossary item) of the cervix that was successfully treated 
Medical conditions 
  • have heart problems
  • have or have had a blockage in a vein in your eye called the retinal vein
  • have a lung condition called intestinal disease or pneumonitis
  • have had major surgery in the last 2 weeks
  • have HIV
  • have any other medical condition or mental health problem that the study team think would affect you taking part
  • are sensitive to dabrafenib or trametinib
  • take medication that affects body substances called CYP enzymes in the liver or herbal medicines
  • are pregnant or breastfeeding 

Trial design

This is a phase 3 study. It is taking place worldwide. The researchers need 600 people to take including 30 from the UK.
Everyone has dabrafenib and trametinib. Dabrafenib is a capsule. Trametinib is a tablet. 
You take:
  • dabrafenib capsules twice a day, everyday
  • trametinib tablets once a day, everyday 
You have treatment for up to 1 year. 
Managing a fever
The most common side effect of the combination of dabrafenib and trametinib is a fever. Take your temperature if you are feeling unwell. The study team will ask you to contact them if your temperature is 38°C or above. They will tell you what to do. They will follow the specific guidelines in the trial protocol to bring your temperature down to normal as quickly as possible.  This might involve stopping treatment for a short time and taking some medication. 
The study team will collect information about fevers, hospital stays and if you had to stop treatment and for how long. 
If during the study your melanoma comes back you may have to stop treatment and your doctor will talk to you about other treatment options. 
Quality of life
The study team will ask you to fill out a questionnaire before you start treatment and at set times during treatment. The questionnaire will ask about side effects and how you’ve been feeling. This is called a quality of life survey Open a glossary item.

Hospital visits

You’ll see a doctor and have some tests before you can take part. These include:
  • physical examination
  • eye examination
  • examination of your skin
  • blood samples
  • heart trace (ECG) Open a glossary item
  • heart scan (echocardiogram) Open a glossary item
  • CT scan or MRI scan
You see the study doctor once a month for a check up and blood tests. They’ll give you a fresh supply of tablets at each visit.
During treatment, you have a CT scan at month:
  • 3
  • 6
  • 12
Follow up
The study team follow you up every 3 to 6 months after you complete 12 months of treatment.  The total period for treatment and follow up will last for up to 2 years. 
After 2 years of follow up the study team will phone you every 3 months to see how you are getting on. 

Side effects

The study team will monitor you during the time you have treatment and you’ll have a phone number to call if you are worried about anything. 
Please contact the study team straight away if you get a high temperature either the first time or if it gets worse. A high temperature is 38°C or higher on a thermometer. 
The study team will tell you what to do about your fever if you develop one. 
The most common side effect of the combination of dabrafenib and trametinib are:
  • high temperature (fever)
  • an increased risk of bleeding
  • chills
  • liver changes
  • high blood pressure
  • swelling or pain in the arms or legs
  • redness and swelling of the throat and nostrils
  • loss of appetite
  • headache
  • dizziness
  • cough
  • tummy (abdominal pain)
  • constipation or diarrhoea
  • feeling or being sick
  • tiredness (fatigue) or weakness
  • painful, stiff joints or muscle pain 
We have more information about dabrafenib

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Pippa Corrie

Supported by


If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Charlie took part in a trial to try new treatments

A picture of Charlie

“I think it’s really important that people keep signing up to these type of trials to push research forward.”

Last reviewed:

Rate this page:

Currently rated: 5 out of 5 based on 1 vote
Thank you!
We've recently made some changes to the site, tell us what you think