The combination of BRAF inhibitor with MEK inhibitor treatment significantly improved overall survival in metastatic melanoma with BRAF mutation without increased overall toxicity. However, no previous data have been reported on the safety and efficacy of dabrafenib and trametinib combination therapy in extremely aged patients. Here, we present a case of durable clinical benefit with the use of dabrafenib and trametinib in a super-elderly patient with BRAF-mutated metastatic melanoma.
In August 2017, a 90-year-old Korean man was referred to our institution for excision of a cutaneous lesion on the back, which was diagnosed as a malignant melanoma. A physical examination revealed a hard, palpable mass on back. A full body CT scan revealed the presence of several masses at the liver and LDH levels were normal. Our patient underwent a wide excision of the back mass and core needle biopsy of the largest hepatic lesion in right hepatic lobe without any complications. Pathologic results were diagnosed as malignant melanoma in both the back and liver. Therefore the biopsy specimen was studied for mutations in BRAF, and V600E mutation was detected in the BRAF gene. Our patient was evaluated with an excellent quality of life, with an ECOG performance status of 1 with moderate comorbidity. In November 2017, he was started with dabrafenib 150 mg orally twice per day plus trametinib 2 mg orally once per day. No adverse events were observed other than grade 1 pyrexia and grade 1 diarrhea, based on the CTCAE (version 5.0) while the patient was taking these drugs and the side effects were manageable. His first radiological evaluation by CT scan, 3 months after starting treatment, showed a partial response by RECIST 1.1 criteria, and six months after initial therapy, the liver metastases had disappeared in the CT scan. Thus, we diagnosed the patient with clinical complete response. Treatment tolerance was well and the patient currently continues treatment with dabrafenib and trametinib without dose reduction.
In conclusion, this case indicates that for selected super-elderly patients with BRAF-mutated metastatic melanoma, treatment with combined dabrafenib and trametinib may be safe and effective therapy.