PMID- 31157737
OWN - NLM
STAT- MEDLINE
DCOM- 20201104
LR  - 20210124
IS  - 1473-5636 (Electronic)
IS  - 0960-8931 (Linking)
VI  - 30
IP  - 2
DP  - 2020 Apr
TI  - New primary melanoma in a patient under triple therapy with vemurafenib, 
      cobimetinib, and atezolizumab for metastatic melanoma.
PG  - 206-208
LID - 10.1097/CMR.0000000000000627 [doi]
AB  - New primary melanomas (NPMs) in the era of combination treatments for melanoma 
      constitute a challenge for physicians, especially due to the increased incidence 
      of NPMs in patients treated with BRAF inhibitors. We present the unique case of a 
      patient that developed an invasive NPM while under treatment with a combination 
      of vemurafenib, cobimetinib, and atezolizumab. A 39-year-old white male was 
      treated with vemurafenib, cobimetinib, and atezolizumab for a stage IV (T0, N3, 
      M1) BRAF-V600E mutated malignant melanoma in the context of a clinical trial. 
      Eight months from treatment initiation he was diagnosed with an NPM on his back 
      that was found to be BRAF-wild type and neuroblastoma ras mutated, while he was 
      in complete remission. Wide excision of the lesion followed, and the patient was 
      not withdrawn from study treatment. Twenty-two months from treatment initiation, 
      he is still in complete remission. NPMs are a well-known adverse effect of BRAF 
      inhibitors and pose a challenge for the treating physician since these lesions 
      are BRAF-wild type and usually have aggressive biologic behaviour. Invasive NPMs 
      require an aggressive management strategy with clear guidelines to prevent the 
      emergence of advanced or metastatic disease. The emergence of invasive NPMs in 
      patients treated with triple regimens with BRAF/mitogen-activated protein kinase 
      kinase inhibitors and PD1/PDL1 inhibitors is at least unexpected and constitutes 
      a therapeutic stalemate for the physician. Through this case report, we aim to 
      increase awareness about the diagnosis and management of patients with NPM and to 
      express our concerns regarding further management of NPMs in patients under 
      triple combination treatment.
FAU - Diamantopoulos, Panagiotis T
AU  - Diamantopoulos PT
AD  - First Department of Internal Medicine, Laikon General Hospital.
FAU - Lakiotaki, Eleftheria
AU  - Lakiotaki E
AD  - Department of Pathology, National and Kapodistrian University of Athens, Athens, 
      Greece.
FAU - Kyriakakis, Georgios
AU  - Kyriakakis G
AD  - First Department of Internal Medicine, Laikon General Hospital.
FAU - Gogas, Helen
AU  - Gogas H
AD  - First Department of Internal Medicine, Laikon General Hospital.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Melanoma Res
JT  - Melanoma research
JID - 9109623
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Azetidines)
RN  - 0 (Piperidines)
RN  - 207SMY3FQT (Vemurafenib)
RN  - 52CMI0WC3Y (atezolizumab)
RN  - ER29L26N1X (cobimetinib)
SB  - IM
MH  - Adult
MH  - Antibodies, Monoclonal, Humanized/pharmacology/*therapeutic use
MH  - Antineoplastic Combined Chemotherapy Protocols/pharmacology/*therapeutic use
MH  - Azetidines/pharmacology/*therapeutic use
MH  - Humans
MH  - Male
MH  - Melanoma/*drug therapy/pathology
MH  - Neoplasm Metastasis
MH  - Piperidines/pharmacology/*therapeutic use
MH  - Skin Neoplasms/*drug therapy/pathology
MH  - Vemurafenib/pharmacology/*therapeutic use
EDAT- 2019/06/04 06:00
MHDA- 2020/11/05 06:00
CRDT- 2019/06/04 06:00
PHST- 2019/06/04 06:00 [pubmed]
PHST- 2020/11/05 06:00 [medline]
PHST- 2019/06/04 06:00 [entrez]
AID - 00008390-202004000-00012 [pii]
AID - 10.1097/CMR.0000000000000627 [doi]
PST - ppublish
SO  - Melanoma Res. 2020 Apr;30(2):206-208. doi: 10.1097/CMR.0000000000000627.