1 / 5

Which patients / tumors should be tested for BRAF mutation?

Which patients / tumors should be tested for BRAF mutation?. If so, at what stages and when in the course of their disease? Which eligible BRAF mutated patients should receive BRAF inhibitors?. BRAF testing: F or whom?.

demont
Download Presentation

Which patients / tumors should be tested for BRAF mutation?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Which patients / tumors should be tested for BRAF mutation? If so, at what stages and when in the course of their disease? Which eligible BRAF mutated patients should receive BRAF inhibitors?

  2. BRAF testing: For whom? Given the availability of 2 adjuvant trials for resected stage III melanoma • 1 with vemurafenib • 1 with dabrafenib + trametinib • We suggest testing all patients diagnosed at stage IIIB or higher, and all patients with newly diagnosed stage IV disease The FDA approved COBAS test, or a validated pyrosequencing or other assay may be used • IHC testing is still not quite validated and ready for prime time

  3. Which eligible BRAF mutated patients should receive BRAF inhibitors? Should the choice be based on tumor size / bulk, LDH levels, rate of growth?

  4. Who should receive BRAF inhibitors? Ackerman et al, ASCO 2012; 8569 Asciertoet al, J Transl Med 2012; 10: 107 Vemurafenib before ipilimumab may not be optimal approach for some BRAF-mutated patients • May compromise chance for long-term survival with ipilimumab in some patients Sequencing ipilimumab first followed by vemurafenib may offer best chance for long-term survival in well-selected patients without compromising benefit from subsequent vemurafenib therapy • May be possible to identify those patients at high risk of rapid disease progression upon relapse with a BRAF inhibitor • These patients may benefit from being treated with ipilimumabfirst

  5. Who should receive BRAF inhibitors? For BRAF mutated patients with indolent or low volume disease with low LDH: Ipilimumab and high dose IL-2 can be used before, then vemurafenib / dabrafenib later • Concern that BRAFi failures will not respond to ipi For patients with bulky or rapidly growing BRAF mutated disease, high LDH, symptomatic: BRAFiis used first For BRAF wild type patients: Ipilimumabis most common, IL-2 also used (US), and a trial is next • PD-1/PD-L1 antibody trials are currently open only to ipi (and also IL-2) failures

More Related