ONCAlert | 2018 ASCO Annual Meeting
Melanoma Case Studies

Jason Luke, MD: The Impact of Moderate Level of Disease Burden on Response to Targeted 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

How might this patient's moderate level of disease burden impact response to targeted therapy?

Number of sites of disease and volume has been found to be an important element in mediating response to targeted therapy. And retrospective analysis of multiple clinical trials of the BRAF/MEK combination, dabrafenib, and trametinib has really emphasized that. So, in a patient like Charles, we would strongly consider that as we have developed expectations regarding the efficacy of therapy. It is relative, however, because absolute number of mutations of sites of disease doesn’t necessarily tell you volume of disease. So, in a patient like this who has relatively low volume disease, perhaps that would be different than someone who had three sites of large tumors in the lung or the brain, etc. But we would expect in this patient to see a good response despite two sites of disease and hopefully perhaps even a complete response given the low volume.

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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