Jason Luke, MD: Second-Line Therapy

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

In a patient who has a BRAF mutation and initiates dabrafenib/trametinib as frontline therapy to target that mutation, second-line therapy includes multiple options and really becomes clinically dependent — what’s going on with this patient at the time? Unfortunately, we see that a high percentage of patients who initiate targeted therapy towards BRAF subsequently develop brain metastases as their first site of progression. In that context, then radiation is a likely component to your treatment, and we have to think about whether or not steroids are involved. And that then decides if you can use immunotherapy eventually, etc.

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 aBRAFV600K 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.