ONCAlert | 2017 San Antonio Breast Cancer Symposium
Melanoma Case Studies

Jason Luke, MD: Factors to Consider When Determining Treatment

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

What factors do you consider when determining treatment for patients like Charles?

For a patient like Charles who presents with metastatic disease involving at least two sites here, lung and possibly liver, as well as a normal LDH but possibly not in exactly perfect performance status, there are multiple options that one could consider. But certainly in the context of a V600K mutation, initiation of BRAF/MEK therapy with dabrafenib/trametinib would be completely reasonable. One would expect it to be highly efficacious. This is a patient that would fall sort of into the intermediate risk category in terms of depth of response we would expect, with the risk factors or the factors we would consider being the number of sites of disease, which usually with more than three, we become concerned that perhaps the efficacy will be less. But here with two, with low volume disease, there’s a good chance for a good outcome. Similarly, with LDH, with the LDH being normal, that’s a good sign as well. So, certainly, this would be a very reasonable therapy. We would expect it to be very well tolerated and highly efficacious, and we would follow the patient over time to make sure he’s tolerating well and jump on any problematic areas that might arise later.

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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