Durable complete response in a patient with leptomeningeal melanoma after treatment with dabrafenib, trametinib, and nivolumab Journal Article
| Authors: | Lochrin, S. E.; Buonocore, D. J.; Young, R. J.; Kaley, T. J.; Postow, M. A.; Wolchok, J. D.; Shoushtari, A. N.; Momtaz, P.; Betof Warner, A. S.; Callahan, M. K. |
| Article Title: | Durable complete response in a patient with leptomeningeal melanoma after treatment with dabrafenib, trametinib, and nivolumab |
| Abstract: | Leptomeningeal disease (LMD) is a devastating complication of melanoma with a dismal prognosis. We present the case of a young man with stage IV BRAF V600E mutant melanoma with lung, lymph node, and brain metastases initially treated with ipilimumab and nivolumab, who subsequently developed LMD. Upon change to BRAF/MEK targeted therapy with nivolumab, a durable complete response was achieved and remains ongoing, off treatment, 7 years from diagnosis. Management of symptomatic LMD remains a critical unmet clinical challenge, with limited clinical trial data. This exceptional case is instructive, as the first published case of the use of the triplet, and the first durable response with therapy discontinuation, in melanoma LMD. The triple-drug regimen may be considered a viable option in fit patients. This case highlights the potential for long-term disease control and the critical and urgent need to develop clinical trials inclusive of patients with LMD to define the best treatment strategies. © 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. |
| Keywords: | adult; clinical article; treatment response; cancer surgery; gene mutation; human cell; genetics; prednisone; case report; diarrhea; drug dose reduction; treatment duration; postoperative care; cancer staging; drug megadose; neuroimaging; nuclear magnetic resonance imaging; follow up; lymph node metastasis; antineoplastic agent; cytology; ipilimumab; cancer immunotherapy; melanoma; computer assisted tomography; tumor volume; antineoplastic combined chemotherapy protocols; dexamethasone; bradycardia; pathology; diagnostic imaging; pyrimidinone derivative; pyridones; pyrimidinones; fever; rash; lung metastasis; cancer regression; papilledema; immunotherapy; lumbar puncture; meningeal neoplasms; skin examination; brain metastasis; targeted therapy; headache; stereotactic radiosurgery; drug therapy; ataxic aphasia; b raf kinase; mitogen activated protein kinase kinase; treatment withdrawal; proto-oncogene proteins b-raf; cutaneous melanoma; imidazoles; blurred vision; imidazole derivative; agitation; brain metastases; central nervous system disease; metastatic melanoma; molecularly targeted therapy; deterioration; cerebellum tumor; vitiligo; cauda equina; leptomeningeal disease; dabrafenib; trametinib; pyridone derivative; nivolumab; oximes; humans; human; male; article; oxime; cerebrospinal fluid pressure; triplet chemotherapy; circulating free dna; meningeal tumor; leptomeningeal melanoma |
| Journal Title: | Pigment Cell & Melanoma Research |
| Volume: | 37 |
| Issue: | 6 |
| ISSN: | 1755-1471 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2024-11-01 |
| Start Page: | 801 |
| End Page: | 807 |
| Language: | English |
| DOI: | 10.1111/pcmr.13179 |
| PUBMED: | 38960393 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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