How do you approach a patient with recurrent chest wall BRAF(+) mutated melanoma who developed multiple metastatic axillary nodes while on immunotherapy, now post axillary dissection for adjuvant radiation?

Topics: Melanoma/Skin Cancer • Medical Oncology

Answer from: Medical Oncologist at Academic Institution

This is a patient with recurrent BRAF+ metastatic melanoma who has undergone definitive resection for metastatic lymph nodes. I think it's important to clarify whether this patient progressed after single-agent immune checkpoint therapy (i.e., pembrolizumab or nivolumab) vs dual-immune checkpoint th...

Answer from: Medical Oncologist at Academic Institution

I suggest sending the tissue for next generation sequencing to look for targets. Please repeat a full body PET scan and MRI brain with and without contrast to make sure there is no visible disease. This is a disease with an extremely high risk of relapse. Although there is no precedent, I would reco...

Comments

Medical Oncologist at Southern California Permanente Medical Group
Thank you. I realize I wrote this question hastily...

Medical Oncologist at University Hospitals
This is not a true adjuvant setting, rather a recu...

Answer from: Medical Oncologist at Community Practice

Agree. I also always check if there is a clinical trial open to enroll such patients. If not, I would also administer ipi/nivo.

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