We have detected that you are using an Ad Blocker.
PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.
We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.
The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.
Please provide your AHPRA Number to ensure that you are given the correct level of access to our site.
featured
Published in Advanced Melanoma

Expert Opinion / Cases · July 17, 2021

Recurrent Metastatic Melanoma in Mentally Impaired Patient

Written by
Viola Franke MD

 

Discuss This item Follow

No comments yet, be the first to start the discussion!

  • Ari VanderWalde

    This is a difficult case, with what is clearly a very slow-growing melanoma that has slowly recurred after multiple resections over the course of 10 years. As a medical oncologist, my bias with what is now a 4th recurrence, is to treat systemically. There are two ways to do this- my inclination is to resect the lymph node to NED and then treat adjuvantly with nivolumab or pembrolizumab as per the adjuvant immunothearpy trials. Alternately, you could choose to not resect and treat with either nivolumab alone, pembrolizumab alone, ipi-nivo, or nivo-relatlimab (if/when it becomes available). My bias is also not to treat with BRAF/MEK inhibitor therapy up-front as immune therapy has a greater chance for cure. However, how to sequence BRAF/MEK with ipi/nivo has never been conclusively decided- we are waiting on complete accrual and results from the DREAMseq trial. I would recommend against combination PD-L1+BRAF+MEK as in the IMpsire150 trial despite the positive results and FDA approval as this was compared to BRAF/MEK alone and the correct comparison would have been sequential therapy.


  • Sep 19, 2021

    Pending Moderator approval.
    Delete

Further Reading