How do you manage patients with BRAF V600E-mutated metastatic melanoma who have a mixed radiographic response after several months of therapy with dabrafenib/trametinib?

Does the site of progression or response matter? What if there is progression in the lungs but response in lymphadenopathy, for example?

1 Answer

Mednet Member

Medical Oncology · University of Colorado

Answered on

Good question. This probaby means the patient will not be a long term survivor with targeted agents. The standard thing would be to switch to immunotherapy with either single agent anti PD1 or ipi+nivo combo. A more off base possibility would be to add Pembro to avoid rapid progression upon discontinuation of targets agents. This would not be standard but I think it will be in the future. Dabrafenib and trametinib have been safely combined with Pembrolizumab as have Vemurafenib cobimetinib with atezolizumab. But there is risk of severe liver toxicity With these combinations and insurance coverage for triple drug combos may be difficult.

With regards to sites of progression, the brain is somewhat different as the response to targeted agents and immunotherapy is somewhat lower. So if PD in brain with small lesion(s) easily amenable to Stereotactic RT that would be option. If systemic progression I would switch to immunotherapy or add Pembro