Maximizing BRAF/MEK Inhibition in Melanoma

Source: OncLive, June 2019


Hussein A. Tawbi, MD: Starting patients on BRAF and MEK inhibitors does take quite a bit of education for the patient, and I think from my perspective the most important approach is to really inform the patients of what to expect. We spend some time with them going through the timing of different potential adverse effects. I highlight the fact that they need to try and hydrate themselves very well, for instance. When they start experiencing any sort of fevers, it starts usually with chills that then go to low-grade fever, then go to high-grade fever. So I make a really significant point for patients, and I harp on that several times, that if you start experiencing that sequence, from chills to low-grade fevers, that would be a really good time to actually stop your medications.

It’s interesting because most patients are really concerned about stopping early a medication that they know is designed to help their tumor. But we really educate them that those dose interruptions are not necessarily going to impact the efficacy part, right? So that’s one big aspect of really focusing on the fever and educating them on how to manage it and how to hydrate themselves to prevent worsening of the fevers or resulting in hypotension or renal failure or anything like that. The other piece is we educate them about sun safety, which is part of our education for any melanoma patient. But we also highlight the fact that they may be a bit more sensitive to the sun, depending on which combination we use obviously. So if we’re doing vemurafenib, cobimetinib, that’s a significant discussion because patients can really have a lot of issues with photosensitivity.

And at the end, we do highlight the fact that if those adverse effects do happen with you, reach out to our team. We really highlight and stress the communication piece, and for those patients to really reach out to us and ask us questions. And our team then handles those things, basically assesses how severe the patient’s condition is and then gives them the best ways of how to handle a toxicity.

read the original full article