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

Jason Luke, MD: The Impact of BRAF/MEK Inhibitors in Melanoma

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 impact have BRAF/MEK inhibitors had, since their initial approval, and how has this changed mutation testing for melanoma?

The development of selective BRAF inhibitors, and subsequently the addition of MEK inhibitors, has really had a transformative impact on the treatment of metastatic melanoma. And the context of mutational profiling has really emphasized now that BRAF mutational testing for all cutaneous melanomas is a standard of care and should be performed immediately, essentially as soon as a patient is diagnosed. It is a truly effective therapy that needs to be considered for all patients and then put in the context of what else could be possible. But BRAF testing for a cutaneous melanoma is standard of care in the metastatic disease. These therapies can be associated with long-term disease control, perhaps out more than three years in some patients, but it is essential that this test be done. The question then arises, should we do more testing beyond just BRAF testing? But I think that’s beyond the scope of standard clinical practice at this point, but definitely the identification of any V600 mutation in melanoma is a standard of care.

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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