ONCAlert | 2017 San Antonio Breast Cancer Symposium
Melanoma Case Studies

Jeffrey Weber, MD, PhD: The Impact of Moderate Level of Disease Burden on Response to Targeted Therapy

Jeffrey Weber, MD, PhD
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?

There’s a clear association, as seen in a recent study that was published in the Journal of Clinical Oncology by Georgina Long, between your burden of disease and how well you’re going to do with BRAF/MEK inhibition. Interestingly, in the low disease burden normal LDH patients, their one and two year survivals may well be as good as with any immunotherapeutic combination. So, when you look at the patient in the middle who’s got the normal LDH but might have a higher disease burden, it puts you into a middle ground where you can certainly use BRAF plus MEK inhibition, but you’re probably not going to leave them on therapy for a very long time because you don’t want to see the development of resistance. The abnormal performance status and the multiple sites of disease would suggest that’s a patient who’s probably going to eventually develop resistance, and then it may be more difficult to treat them with immunotherapy. You want to intervene sooner and then make that switch to the immunotherapy after a relatively brief period of targeted inhibition.

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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