ONCAlert | 2017 San Antonio Breast Cancer Symposium
Melanoma Case Studies

Jeffrey Weber, MD, PhD: The Role of LDH, Age, and Sites of Disease in Durability of Response

Jeffrey Weber, MD, PhD
Published Online:Aug 18, 2016
Sarah is a 50-year-old Caucasian postal worker who presented to her primary care physician with multiple, skin-colored nodules and palpable lymph nodes. A workup biopsy and mutation test was conducted, which revealed BRAF V600E mutation-positive melanoma that had metastasized to the lymph nodes, subcutaneous tissue, and right adrenal gland. ECOG performance status is 0 and her LDH levels are normal.

Metastatic Melanoma with Jason Luke, MD and Jeffrey Weber, MD, PhD: Case 2

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 role might Sarah's LDH, age, and sites of disease play in the durable response that she experienced?

Being a younger middle aged person, being someone with a good performance status and a pretty minimal or modest disease burden, I think that bodes well for being able to get a good remission. And it probably bodes well not only for having a good remission, but having a remission of durability. So I think there’s clearly an association there. The exact causation of why such a patient should do well with BRAF/MEK inhibition compared to someone who, say, is 10 years older, has a performance status of 1 and might not have that much bigger a disease burden, that’s a real mystery. And I don’t think that we have the answers. All that we do have now is a relatively simple, essentially clinical algorithm for trying to make choices about when to start with BRAF/MEK as opposed to when to start with immunotherapy.

CASE: Metastatic Melanoma

Sarah is a 50-year-old Caucasian postal worker who presented to her primary care physician with multiple, skin-colored nodules and palpable lymph nodes. .

  • A workup, biopsy, and mutation test was conducted, which revealed BRAF V600E mutation-positive melanoma that had metastasized to the lymph nodes, subcutaneous tissue, and right adrenal gland.    
  • ECOG performance status is 0 and her LDH levels are normal.

The patient was started on the combination of dabrafenib and trametinib. She experienced a durable complete response and has remained on therapy for 36 months.

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