Myrdal Caitlyn N, Sundararajan Srinath
University of Arizona College of Medicine, Tucson, AZ, USA.
Hematology and Oncology, Texas Oncology, Houston, TX, USA.
Case Rep Oncol Med. 2020 Jun 25;2020:4392562. doi: 10.1155/2020/4392562. eCollection 2020.
Little is known about the optimal sequencing of targeted therapy and immunotherapy in the treatment of patients with BRAF-mutated metastatic melanoma. BRAF/MEK inhibition often has the benefit of rapid disease regression; however, resistance is frequently seen with long-term use. Treatment with immune checkpoint inhibitors offers the potential for long-term response but displays a lower rate of objective response. The benefit of synergy between therapies is apparent; however, there is limited data regarding optimal sequencing in the treatment of advanced melanoma. We present the case of a 62-year-old gentleman with advanced BRAF-mutated melanoma who followed an unconventional treatment path. After progressing on single-agent vemurafenib, he had response to multiple modalities of immunotherapy before progression. After, he had a substantial response to multiple BRAF/MEK inhibitor rechallenges before developing resistance. The patient is now stable after a retrial of combination immunotherapy. Our case illustrates that with the right sequencing of therapy, meaningful clinical responses can be elicited with rechallenging of targeted therapy and immunotherapy in metastatic melanoma.
关于BRAF突变的转移性黑色素瘤患者治疗中靶向治疗和免疫治疗的最佳顺序，人们了解甚少。BRAF/MEK抑制通常具有疾病快速消退的益处；然而，长期使用时耐药很常见。免疫检查点抑制剂治疗具有产生长期反应的潜力，但客观反应率较低。治疗之间协同作用的益处是明显的；然而，关于晚期黑色素瘤治疗中最佳顺序的数据有限。我们报告一例62岁患有晚期BRAF突变黑色素瘤的男性患者，其遵循了非常规的治疗路径。在单药维莫非尼治疗进展后，他在疾病进展前对多种免疫治疗方式有反应。之后，在出现耐药前，他对多种BRAF/MEK抑制剂再次治疗有显著反应。在联合免疫治疗再次试验后，患者目前病情稳定。我们的病例表明，通过正确的治疗顺序，在转移性黑色素瘤中对靶向治疗和免疫治疗进行再次治疗可引发有意义的临床反应。
