Question 1 of 5

(demo test)

Product Demo for Clinical

A 63-year-old presents to your office with a recent diagnosis of metastatic melanoma BRAF mutant (V600) positive.  Staging imaging demonstrated metastatic disease in the bilateral adrenal glands and involvement of the liver (both lobes). Which of the following treatments would you recommend as first line therapy in this clinical situation? 

A. Cytotoxic chemotherapy

B. Dabrafenib/trametinib

C. IL-2

D. Nivolumab

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Category:

Skin

Topic:

Melanoma

High Yield:

No

Your Answer:

U

Correct Answer:

B

Explanation:

The current standard of care (NCCN guidelines) of patients with metastatic BRAF mutant melanoma is combination therapy using BRAF and MEK inhibition (down stream target of BRAF). One of two BRAF inhibitors are currently used: 

• Vemurafenib
• Dabrafenib

These agents are used in combination with a MEK inhibitor:

• Trametinib

This combination of BRAF/MEK inhibition overall survival (OS), progression-free survival (PFS) and response rates vs. BRAF inhibition alone. This has been demonstrated in a number of phase III randomized control trials (COMBI-d  Long et al. N Engl J Med 2014, Long et al. Ann Oncol 2017 and COMBI-v Robert et al. N Engl J Med 2015).

It is currently unknown if initial immunotherapy or molecular targeted therapy is superior in this clinical situation. This question is currently being addressed in a number of randomized trials.

Clinical Pearl: The current standard of care in patients with BRAF mutant metastatic melanoma is combination therapy using BRAF and MEK inhibition. It should be noted that it is currently unknown if initial immunotherapy or molecular targeted therapy is superior in this clinical situation. This question is currently being addressed in a number of randomized trials. (ECOG EA6134) 

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