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Melanoma — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinMelanomaSCE Medical Oncology

A 52-year-old man presents with widespread metastatic melanoma (BRAF V600E mutant, LDH elevated, high tumour burden). He is symptomatic with rapidly enlarging subcutaneous nodules and liver metastases causing RUQ pain. ECOG PS 1. What is the preferred first-line approach given the urgent need for rapid tumour response?

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Correct answer: E — Dabrafenib + trametinib

When rapid tumour response is needed (symptomatic disease, threatened organ function, high LDH), BRAF-targeted therapy (dabrafenib + trametinib) provides faster responses (median time to response approximately 2 months, response rate approximately 70%) compared with immunotherapy. The caveat is that targeted therapy responses are often less durable than immunotherapy responses. A strategy of initial targeted therapy followed by immunotherapy at progression ('reverse sequencing') is sometimes employed, though optimal sequencing remains debated (DREAMseq trial).

Reference: ESMO 2024 Melanoma Guidelines; DREAMseq Atkins et al JCO 2023; NICE TA396