Safety and rapid response of dabrafenib and trametinib therapy during hyperbilirubinemia in metastatic melanoma

Abstract

This case report describes the occurrence of hyperbilirubinemia as a complication of metastatic melanoma. A 72-year-old male patient was diagnosed with BRAF V600E-mutated melanoma with metastases in the liver, lymph nodes, lungs, pancreas, and stomach. Due to a lack of clinical data and specific guidelines for the treatment of mutated metastatic melanoma patients with hyperbilirubinemia, a conference of specialists debated between initiating treatment or providing supportive care. Ultimately, the patient was started on the combination therapy of dabrafenib and trametinib. This treatment resulted in a significant therapeutic response via normalization of bilirubin levels and an impressive radiological response of metastases just one month post-treatment initiation.

Melanoma Management: Exploring Staging, Prognosis, and Treatment Innovations

“…Understanding the BRAF mutation status has become standard practice in diagnosing melanoma. However, BRAF mutations alone are typically insufficient to initiate tumor formation, as they are also commonly found in most benign nevi [ 4 , 45 , 46 , 47 , 48 ].…”

“…Primary melanomas typically exhibit dark pigmentation, although some can be amelanotic or hypomelanotic. While clinical assessment raises suspicion of melanoma, a histopathological assessment is necessary to confirm diagnosis [ 1 , 2 , 3 , 4 ].…”

“…Malignant melanoma, one of the most prevalent cancers globally, ranked 20% in terms of estimated new cases according to Cancer Statistics Cases (21.2 new cases per 100,000 men and women each year) [ 4 , 5 , 6 ]. While comprising only 4–7% of skin cancers, melanoma is responsible for the majority of skin cancer fatalities [ 4 ].…”

“…Malignant melanoma, one of the most prevalent cancers globally, ranked 20% in terms of estimated new cases according to Cancer Statistics Cases (21.2 new cases per 100,000 men and women each year) [ 4 , 5 , 6 ]. While comprising only 4–7% of skin cancers, melanoma is responsible for the majority of skin cancer fatalities [ 4 ]. Specifically, melanoma of the skin has shown a yearly increase in incidence and is projected to account for over 100,000 new cases and over than 8000 deaths in the USA in 2023 alone, especially within white populations [ 7 ].…”

“…The predominant mutation detected in melanoma patients involves substituting a valine with glutamic acid at the amino acid position 600 (V600E). About 40–60% of melanomas exhibit activating BRAF mutations, with V600E mutations accounting for 70–90% of these cases [ 2 , 3 , 4 , 8 , 9 , 10 ].…”