Treatment exceeds expectations with vemurafenib monotherapy in a patient with BRAF^V600E-mutant metastatic melanoma

Abstract

Introduction Patients with distant metastatic melanoma has a poor prognosis, with a reported median survival time of six to eight months. In modern era, survival has prolonged with the immunotherapy and targeted therapy options. Potent and selective BRAF inhibitors have been developed that specifically inhibit mutated BRAF over other RAF kinases. Vemurafenib was the first selective tyrosine kinase inhibitor developed to target the V600E allele of BRAF-mutant melanoma. Case Report In this report, we present a case of BRAFV600E-mutant metastatic melanoma, which is being treated with vemurafenib monotherapy with complete response for about seven years. Management and Outcome The patient is still being treated with vemurafenib and radiologic complete response is ongoing for about seven years. Discussion Patients treated with BRAF inhibitors monotherapy had promising response rates and improvement in the progression-free survival and overall survival, but melanoma cells became resistant very quickly, affecting the progression. In this case, we present a case that has permanent response to vemurafenib monotherapy.

Cures with B-Raf inhibitors as single agents in metastatic B-Raf mutated melanoma: Curb your enthusiasm?

“…As shown by our case and the case report of Yilmaz et al., 2 long-term responders to single agents B-Raf inhibitors can rarely be seen. And while our patient's response to dabrafenib lasted almost five years, the disease was treatment-refractory at relapse leading to a fatal outcome.…”

“…Combination therapy with B-Raf and MEK inhibitors in B-Raf V600 mutation-positive metastatic melanoma demonstrated rapid response induction associated with symptom control, response rates in the range of 60–70%, and a progression-free survival of approximately 11–12 months. 2–4 Dabrafenib plus trametinib use showed a median overall survival of more than 24 months in this setting, with approximately 20% of patients progression free at 3 years. 3 On the other hand, single agents dabrafenib and vemurafenib demonstrated overall response rates of 50% and a more modest progression-free survival of only 5.5-8.8 months in several trials.…”

“…In a recent paper, Yilmaz and Güven Meşe 2 reported a patient with metastatic B-Raf mutated melanoma who had a complete and durable response to single agent vemurafenib that he maintained for seven years. The authors further call for continuation of this agent long-term, and suggest that cures can be expected with B-Raf inhibitors as single agents in metastatic melanoma.…”

DIRAS2 Is a Prognostic Biomarker and Linked With Immune Infiltrates in Melanoma

“…However, once melanoma metastasizes, its life-threatening risk greatly increases ( 5 ). Despite significant advances in targeted therapies and novel immunotherapies ( 6 , 7 ), the efficacy of all treatments is greatly compromised as compared to active surgical treatment, which is very effective in the early stages of the disease. Thus, there is a need to identify biomarkers that are related to tumors in conjunction with stages that affect prognosis ( 8 – 10 ).…”