ONCAlert | 2017 San Antonio Breast Cancer Symposium
Melanoma Case Studies

Jason Luke, MD: Second-Line Therapy

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

If required, what would your second-line therapy be?

In a patient who has a BRAF mutation and initiates dabrafenib/trametinib as frontline therapy to target that mutation, second-line therapy includes multiple options and really becomes clinically dependent – what’s going on with this patient at the time? Unfortunately, we see that a high percentage of patients who initiate targeted therapy towards BRAF subsequently develop brain metastases as their first site of progression. In that context, then radiation is a likely component to your treatment, and we have to think about whether or not steroids are involved. And that then decides if you can use immunotherapy eventually, etc.

In a patient who has low volume metastasis or progression, we would probably use a monotherapy PD-1 agent. But if a patient had massive progression, you then might go to combination immunotherapy – ipilimumab plus nivolumab. Again, in the context of do you need to do radiation concurrently or before that therapy, and does the patient require steroids. So there are multiple immunotherapy options that certainly would be considered as standard and that sort of goes to what’s going on with this patient at that moment.

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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