Thursday, 8 June 2017

Treatment options for patients with localized metastatic melanoma -a study case

Overview on the subject HERE

Localized metastatic melanoma- a study case by Dr. Vervon Sondak

Study case of a patient, female , 43 years old
Diagnosed IIIC with melanoma-left buttock, 3 left inguinal limphnodes positive for melanoma;

Three options were considered by her team:

1)      Perform CLND (complete lymphnodes dissection)
This is reducing the risk of recurrence, but not difference in 3 years OS when compared CLND with only monitoring (see DeCOG-SLT trial on 483 patients); when macrometastasis present and more lymphnodes positive CLND is encouraged (high risk melanoma pts); it is offering a good control of disease but not increasing Overall Survival, see update by Faries et al, 2017 NEJM
Adjuvant radiotherapy- could lower the rates of relapse but increases the occurrence and complications of  lymphedema. In this case CLND (complete limphnode dissection) was refused by patient.

-          2) Recommend interferon (IFN alfa) or ipilimumab- not appropriate for patients with large relapsed limphnodes- unfortunately the patient in this study case received IFN
-          3) Clinical trial with an anti-PD1 or targeted therapy
Patient was Braf negative. In one year unfortunately patient relapsed - stage IVM1b,
She was treated with the combination ipi/nivo;

Note: patients that could mostly benefit of combi are the ones with Braf mutation, high  LDH and low PDL1 expression/patients with rapid progression.

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