Exclusion criteria vs reality: dual BRAF/MEK inhibition and radiotherapy in a patient with melanoma metastatic to the brain and ECOG 3

BACKGROUND

Prognosis of metastatic melanoma is changing due to advances in immunotherapy and targeted therapy. However, management of patients with brain metastases in day-to-day practice continues to be a challenge.

CASE REPORT

We describe a 40-year-old woman diagnosed with symptomatic brain metastases from cutaneous melanoma and Eastern Cooperative Oncology Group 3. She was treated, off label, with BRAF inhibitor (dabrafenib) + MEK inhibitor (trametinib) and radiotherapy. There was significant, long-lasting, response (17 months), no clinically relevant toxicity, and clear improvement in quality of life.

CONCLUSIONS

This case is an example of real-life application of advances in targeted therapy.

The use of vemurafenib in Australian patients with unresectable or metastatic melanoma containing the V600 BRAF gene mutation

Metastatic melanoma remains one of the major causes of death related to skin cancers and has been resistant to traditional anticancer therapies. The clinical development of vemurafenib in the treatment of metastatic melanoma with the V600 mutation of the BRAF gene has provided meaningful improvements in the overall survival and progression-free survival of metastatic melanoma patients. However, significant side effects have been noted with this therapy, in particular cutaneous adverse events (AEs) such as rashes, squamous cell carcinoma and severe photosensitivity to UVA light among others. With an emphasis on the Australian perspective, this review provides an overview of the clinical development of vemurafenib, its attendant dose-limiting toxicities and other AEs, recommendations for safety monitoring, supportive treatments of AEs and dose modifications, with the aim of maximizing the chances of continuing beneficial treatment.

[What’s new in dermato-oncology?]

During this year 2013, Onco-dermatology was the object of numerous publications, especially in the field of metastatic melanoma. Previous results concerning anti PD-1 have been consolidated. Studies concerning Mek inhibitors have been published with promising results in uveal melanoma. In metastatic melanoma two combinations showed great results: combination of ipilimumab and nivolumab and combination of B-RAF and MEK inhibitors. Some studies demonstrated efficacy of these new therapeutics (ipilimumab, vemurafenib and dabrafenib) in brain metastasis. Moreover, the year 2013 was marked by the increasing knowledge in the management of adverse events induced by these new treatments. In the field of basal cell carcinoma, after the publication of large scale studies, vismodegib, the inhibitor of the hedgehog signalling pathway, was approved by the European Medicines Agency.