ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Melanoma Case Studies

Jason Luke, MD: Durability of a Response to Targeted Therapy Combination

Jason Luke, MD
Published Online:Aug 16, 2016
Charles is a 62-year-old Caucasian landscaper, presented to his primary care physician with fatigue, dyspnea upon exertion, and a nonproductive cough that has lasted for 6 to 8 weeks. Following a medical examination, a suspicious mole was biopsied, which resulted in a diagnosis of melanoma. Genetic testing revealed a BRAF V600K mutation. PET/CT scan shows metastases to the lung and a soft tissue nodule in the liver of 1.4 cm x 1.1 cm. LDH levels and liver function test results were normal. The patient's ECOG performance status was 1. Treatment was initiated with the combination of BRAF and MEK inhibitors.

Metastatic Melanoma with Jason Luke, MD and Jeffrey Weber, MD, PhD: Case 1

Metastatic Melanoma with Jason Luke, MD and Jeffrey Weber, MD, PhD: Case 1
Metastatic Melanoma with Jason Luke, MD and Jeffrey Weber, MD, PhD: Case 2

How durable of a response to the targeted therapy combination would you anticipate for this patient, based on LDH levels, age, and sites of disease?

Risk factors for the depth of response and the median progression-free survival certainly are influenced by factors such as LDH, sites of disease, and overall tumor burden. LDH particularly falls out of almost every analysis. It’s very, very important, and those patients with low LDH tend to have much more extended benefit from targeted therapy relative to those with a high LDH. And this plays out in the longer term data where we see approximately 30% of patients who initiate the dabrafenib plus trametinib as being out three years still on drug. And, in that population, those patients almost entirely had low LDH at the beginning of treatment. So that certainly is a good sign for this patient. And, again, in the context of moderate to low volume of disease, we’d expect a very good outcome.

CASE: Metastatic Melanoma

Charles, a 62-year-old Caucasian landscaper, presented to his primary care physician with fatigue, dyspnea upon exertion, and a nonproductive cough that has lasted for 6 to 8 weeks. .

  • Following a medical examination, a suspicious mole was biopsied, which resulted in a diagnosis of melanoma.
  • Genetic testing revealed a BRAF V600K mutation
  • PET/CT scan shows metastases to the lung and a soft tissue nodule in the liver (1.4 cm x 1.1 cm)
  • LDH levels and liver function test results were normal
  • The patient’s ECOG performance status was 1

Treatment was initiated with the combination of BRAF and MEK inhibitors.

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