Treatment with encorafenib and binimetinib of elderly female patient with BRAF-mutated melanoma with central nervous system metastases
Abstract
Metastases in central nervous system are relatively common in patients with melanoma. Treatment of these patients
should be carried out in multidisciplinary teams and may include systemic therapy, radiotherapy, neurosurgery
and symptomatic management. About half of melanoma patients have a mutation in the BRAF gene. In its presence,
the risk of brain metastases is slightly higher and the prognosis is worse. Currently, both immunotherapy
and molecularly targeted anti-BRAF and anti-MEK therapies are available for the treatment of these patients. The
treatment strategy should be based on the parameters related to the neoplastic disease as well as the patient’s
general condition, comorbidities and patient preferences. One of the treatment options with BRAF/MEK inhibitors
is encorafenib with binimetinib. The following paper describes the case of an 81-year-old patient treated with this
combination for about a year with good tolerance.
Keywords: melanomaBRAF mutationtargeted therapybrain metastases
References
- Long GV, Trefzer U, Davies MA, et al. Dabrafenib in patients with Val600Glu or Val600Lys BRAF-mutant melanoma metastatic to the brain (BREAK-MB): a multicentre, open-label, phase 2 trial. Lancet Oncol. 2012; 13(11): 1087–1095.
- Derks SH, de Joode K, Mulder EE, et al. The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma. ESMO Open. 2022; 7(6): 100600.
- Ramakrishna N, Margolin KA. Multidisciplinary approach to brain metastasis from melanoma; local therapies for central nervous system metastases. Am Soc Clin Oncol Educ Book. 2013: 399–403.
- Tawbi HA, Boutros C, Kok D, et al. New Era in the Management of Melanoma Brain Metastases. Am Soc Clin Oncol Educ Book. 2018; 38: 741–750.
- O'Shea PJ, Tatineni V, Rauf Y, et al. Outcomes of BRAF Mutated vs. Wild Type Tumors in Melanoma Brain Metastasis. International Journal of Radiation Oncology*Biology*Physics. 2021; 111(3): e576.
- Venur VA, Kotecha R, Chen Z, et al. Impact of BRAF mutation in patients with brain metastasis from melanoma. Journal of Clinical Oncology. 2015; 33(15_suppl): e13016–e13016.
- Holbrook K, Lutzky J, Davies MA, et al. Intracranial antitumor activity with encorafenib plus binimetinib in patients with melanoma brain metastases: A case series. Cancer. 2020; 126(3): 523–530.
- Marquez-Rodas I, Arance A, Guerrero MAB, et al. 1038MO Intracranial activity of encorafenib and binimetinib followed by radiotherapy in patients with BRAF mutated melanoma and brain metastasis: Preliminary results of the GEM1802/EBRAIN-MEL phase II clinical trial. Annals of Oncology. 2021; 32: S870.
- Marquez-Rodas I, Fernandez AMA, Guerrero MAB, et al. 826P Encorafenib and binimetinib followed by radiotherapy for patients with symptomatic BRAF mutated melanoma brain metastases: GEM1802/E-BRAIN clinical trial. Annals of Oncology. 2022; 33: S926.
- Long GV, Atkinson V, Lo S, et al. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol. 2018; 19(5): 672–681.
- Tawbi HH, Forsyth P, Algazi A, et al. Efficacy and safety of nivolumab (NIVO) plus ipilimumab (IPI) in patients with melanoma (MEL) metastatic to the brain: Results of the phase II study CheckMate 204. Journal of Clinical Oncology. 2017; 35(15_suppl): 9507–9507.
- Tawbi HA, Forsyth PA, Hodi FS, et al. Safety and efficacy of the combination of nivolumab plus ipilimumab in patients with melanoma and asymptomatic or symptomatic brain metastases (CheckMate 204). Neuro Oncol. 2021; 23(11): 1961–1973.
- Long G, Atkinson V, Lo S, et al. Five-year overall survival from the anti-PD1 brain collaboration (ABC Study): Randomized phase 2 study of nivolumab (nivo) or nivo+ipilimumab (ipi) in patients (pts) with melanoma brain metastases (mets). Journal of Clinical Oncology. 2021; 39(15_suppl): 9508–9508.
- Long GV, Atkinson VG, Lo S, et al. Long-term outcomes from the randomized phase II study of nivolumab (nivo) or nivo+ipilimumab (ipi) in patients (pts) with melanoma brain metastases (mets): Anti-PD1 brain collaboration (ABC). Annals of Oncology. 2019; 30: v534.
- Gutzmer R, Eigentler T, Mohr P, et al. 1104P Nivolumab (NIVO) monotherapy or combination therapy with ipilimumab (NIVO+IPI) in advanced melanoma patients with brain metastases: Real-world evidence from the German non-interventional study NICO. Annals of Oncology. 2020; 31: S746–S747.
- Ugurel S, Thirumaran RK, Bloethner S, et al. B-RAF and N-RAS mutations are preserved during short time in vitro propagation and differentially impact prognosis. PLoS One. 2007; 2(2): e236.
- Keilholz U, Ascierto PA, Dummer R, et al. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol. 2020; 31(11): 1449–1461.