ONCAlert | 2018 ASCO Annual Meeting
Melanoma Case Studies

Jeffrey Weber, MD, PhD: Factors to Consider When Determining Treatments

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 are the factors that you consider when determining treatments for patients like Sarah?

Sarah is a patient with a pretty modest burden of disease, normal LDH, probably asymptomatic other than feeling the lesions, and good performance status. This is the classic patient where we think of two things. You’re either going to go for a straightforward single agent PD-1 blocking agent like pembrolizumab or nivolumab, or you’re going to pay attention to the most recent data that was published in JCO and say to yourself, well, since this is a V600E mutated patient, why couldn’t you use BRAF plus MEK, and maybe get as good an outcome in terms of longevity and durability as immunotherapy?

So you can put both of these choices to the patient.  There will be advantages either way. It’s very difficult to prove to anyone that one is clearly better than the other, but both of them are reasonable options. It’s not a patient with a high disease burden, galloping disease, where you’re really committed to BRAF plus MEK to just get control of the situation. On the other hand, it’s not a patient who has resectable stage IIIb disease where you’re just going to do surgery and consider them maybe for an adjuvant trial. I think you have a lot of options here, and it’s a choice that ultimately will go to the patient.

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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