Molecular Testing for Stage III Melanoma

Source: OnecLive, July 2019

Transcript:

Jeffrey S. Weber, MD, PhD: OK. So the patient then goes to the surgeon. They also go to the medical oncologist. Hussein, what kind of testing do you do in a stage III patient who presents to you in clinic?

Hussein A. Tawbi, MD, PhD: Thank you, Jeff. I mean, what Vern started with is to say that now this requires multidisciplinary management. It always has been, but as we evolve our surgical approaches and actually do fewer surgical interventions that can leave our patients with lymphedema, we also get the chance to apply the recent results of adjuvant therapy trials that have proved benefit and are proven to be safe. As you guys know, we have now 3 adjuvant therapies that are actually FDA approved for the management of high-risk stage III melanoma patients. Those include 2 immunotherapy drugs. Both use the single agents—nivolumab and pembrolizumab.

And then we have, obviously, dabrafenib and trametinib as the combination targeted therapy that’s appropriate for patients who are BRAF mutant. So given that the BRAF-mutant population is appropriate for adjuvant therapy with targeted therapy, we feel strongly about actually understanding whether our patients have the BRAF mutation. We always include a period of time of waiting for the BRAF tests to come back, so we can tell if our patients are BRAF mutant or not so that they know which adjuvant therapy options could be available to them. In certain cases, patients prefer to use immunotherapy up front. In those cases, we may decide to start adjuvant treatment with immunotherapy before we hear about the results. But we make a very significant kind of push to make sure that our patients are aware of all the options available to them, and that does include BRAF testing in this space.