Alternative use of BRAF inhibitors in patients with metastatic melanoma unable to swallow pills

Abstract

Introduction BRAF and MEK inhibitors have been approved for use in metastatic melanoma therapies. All of them are administered as oral capsules or pills. We report two cases treated applying an alternative method of vemurafenib or debrafenib-trametinib administration in patients unable to swallow. Case Report The first case involved a 38-year-old man who was referred to a dermatologist for dysphagia and anorexia. After a computerized tomography (CT) scan it was concluded that the dysphagia was due to compression by mediastinal metastasis in a context of metastatic BRAF mutant melanoma. The second case involved a 35-year-old man who was diagnosed in March 2017 with melanoma of the back of the hand. Several months later a positron emission tomography (PET)/CT scan was performed. It revealed multiple disseminated metastasis. Management & Outcome: The first patient presented total dysphagia and was unable to swallow pills. It was decided to dissolve vemurafenib in order to facilitate administration. Dysphagia was improved 48 hours later, and oral feeding was reintroduced. Due to severe tablet phobia, the second patient was unable to swallow pills. Dabrafenib capsules were emptied and trametinib pills were grinded. One month later, we noted improved health associated with reduction of the metastases. Discussion Our study highlights the possibility of crushing or dissolving BRAF and MEK inhibitors in metastatic melanoma patients for whom it is impossible to swallow pills, eliciting a response and achieving significant if temporary clinical benefit.

Medication use process and assessment of extemporaneous compounding and alternative routes of administration of oral oncology drugs: Guidance for clinical and oncology pharmacists

“…Review of agents found 36 (31%) with guidance for alternative routes of administration readily available in tertiary resources or commercial liquid formulations, 38 (33%) with off‐label manufacturer information or case reports describing manipulation of solid dosage formulations, and 42 (36%) with no data or insight limited to pharmacokinetic studies. Findings are detailed in Table 3 10‐196 . Unique administration instructions (ie, with or without foo...…”