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Melanoma Case Studies

Jeffrey Weber, MD, PhD: Durability of a Response to Targeted Therapy Combination

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 durable of a response to the targeted therapy combination would you anticipate for this patient, based on LDH levels, age, sites of disease? 

For a 62-year-old patient, I would say age would fall out as a major factor that would determine durability of response. I think the more important factors are burden of disease and LDH. From the LDH point of view, the patient has a favorable durability. From the total number of sites of disease, we don’t exactly know how many, but if he has multiple pulmonary nodules and a liver nodule, probably fairly unfavorable because it’s three or fewer sites of disease that determines how durable that response is going to be. This is a patient who falls into a middle ground, and while it wouldn’t be unreasonable to have this V600K mutated patient be on BRAF/MEK for a while, most patients in this category I believe will develop resistance which is why I think eventually, perhaps sooner than later, they’ll come to the use of immunotherapy.

 

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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