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

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?

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.