Adil Daud, MD: Ordering BRAF Reflexively Upon Diagnosis in Melanoma

Should testing for BRAF be ordered reflexively upon diagnosis?

Yeah, it’s a good idea to do them reflexively because it takes a fair amount of time to actually do these tests. The one area that takes a significant amount of time is actually to identify the patient’s tissue blocks and then get them from the place where the initial biopsy was done and then send them to the lab, which does the testing but not always the same place. If you’re testing at a community oncology practice, it takes some time to actually acquire the primary samples and then have them shipped out from your office or from your pathology department. So just in the interest of time, we get reflexive testing done at the time when patients are first biopsied showing they have metastatic disease.

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 ofBRAF-positivity, Michelle was prescribed the combination of dabrafenib (150 mg BID) and trametinib (1 mg daily)