ONCAlert | 2018 ASCO Annual Meeting
Melanoma Case Studies

Boris C. Bastian, MD, PhD: Upfront BRAF Testing in Melanoma

Boris C. Bastian, MD, PhD
Published Online:Aug 03, 2016
Michelle is a 55-year old who was referred by her primary care physician to receive a biopsy for a suspicious mole during a routine visit. Results of the biopsy and other subsequent tests revealed that she had an M1b stage tumor (lung metastasis and a less than ULN LDH level). Her ECOG PS is 0.

Metastatic Melanoma with Adil Daud, MD and Boris C. Bastian, MD, PhD



Should there be upfront testing for BRAF and what is the best process for ordering and conducting tests?

That depends on what the first-line therapy is, and again, also on the pretest probability of what melanoma are we looking at. If the first-line therapy is for example, an immunotherapy, immune checkpoint blockade, I don’t think there is a need for BRAF testing. I think it should be tested for if there is the willingness to act on a positive result and give a BRAF plus MEK inhibitor.

CASE: Metastatic Melanoma

Michelle is a 55-year old who was referred by her primary care physician to receive a biopsy for a suspicious mole during a routine visit. Results of the biopsy and other subsequent tests revealed that she had an M1b stage tumor (lung metastasis and a less than ULN LDH level). Her ECOG PS is 0.

  • Initial BRAF testing using a laboratory-developed test was negative for BRAF V600E L
  •  She was referred from the community setting to a tertiary center, at which point a second test was conducted using the bioMérieux HxID-BRAF kit. This assay was positive for the BRAF V600K mutation
  • Following the finding of BRAF-positivity, Michelle was prescribed the combination of dabrafenib (150 mg BID) and trametinib (1 mg daily)
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