ONCAlert | 2018 ASCO Annual Meeting
Melanoma Case Studies

Jason Luke, MD: Predicting Which Patients Will Experience Durable Responses to Targeted Therapy

Jason Luke, MD
Published Online:Aug 17, 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 can be done to help predict which patients might experience durable responses to targeted therapy, like Sarah's?

Factors that might predict the benefit over a long period of time for targeted therapy are currently under development. The research space, what we have available now really, are clinical factors such as age—younger being more likely to respond and do better over time—low LDH, sites of disease being less than three and not liver metastases as well as not brain metastases obviously. Those are really the predictors that we have to try to identify patients right now.

There’s a big movement in the field, however, to try to look at tumor-based genomic characteristics that might be able to predict response, or maybe even better, are the predictive markers we could find from the peripheral blood, where perhaps after a patient started treatment for say two weeks, we then draw their blood and get an indication from some blood-based biomarker, how well the therapy is likely to work over the long haul. So those types of experiments are ongoing, and large scale clinical trials are being developed to try to look at some of these issues. But, at the current time, we’re really using clinical factors in clinical practice to try to help us know which patients to select for upfront targeted therapy.

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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