ONCAlert | 2018 ASCO Annual Meeting
Melanoma Case Studies

Jeffrey Weber, MD, PhD: Second-Line 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

If required, what would your second-line therapy be?

If someone goes on targeted therapy with BRAF plus MEK inhibition and then progresses, the next choice of course would be an immunotherapy. We will meet with patients and give them options, but if someone progresses with a fair burden of disease that’s symptomatic with a performance status of 1 and even an elevated LDH, they’re probably going to go on the combination of ipilimumab and nivolumab, an approved regimen. If it’s a person who’s elderly and/or with multiple comorbidities, I would hesitate to risk the severe side effects of that regimen and they may go on a single agent like nivolumab or pembrolizumab.

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.

Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.