BRAF Mutation

Josh, when it's possible, surgery is always the best option for treating melanoma. If you only have one or two mets that can be surgically removed, then they are GONE! You are then considered NED. So it's good that your mets can be surgically removed. 

BRAF and MEK are two proteins that cause melanoma cells to proliferate without stopping. Theoretically,if you can inhibit those proteins, you can stop the tumors from growing and even kill the tumor cells. Unfortunately, there is no drug that can inhibit the normal (or "wild type") BRAF protein. There are, however, two drugs that can inhibit the BRAF protein if it contains a certain mutation (called the V600E,K mutation). About 50% of melanomas contain that mutation, so those patients might benefit from taking a BRAF inhibitor. Those inhibitors are called vemurafenib (trade name Zelboraf) and dabarafenib (trade name Tafinlar).

When these BRAF drugs work (in about 50% of the people who take them) they work quickly and well– shrinking tumors within a few weeks. Unfortunately, most melanoma cells eventually become resistant to the BRAF inibitors within 6-9 months, so the good effects don't last very long. And, of course, there are some nasty side effects. Therefore, the BRAF inhibitors are usually used as a short-term "emergency" meaasure in people with severe and/or rapidly spreading Stage IV melanoma. You're not nearly there, and you may never be there.

There are a couple of other inhibitors for MEK, the other proliferative protein. The one that was just recently approved by the FDA is called trametinib (tracde name Mekinist). You do not need to have any mutations to take MEK inhibitors. It does stop and/or kill melanoma in some patients, but not in as many people as the BRAF inhibitors do. What the doctors have learned over the last few years is that taking both a BRAF inhibitor and a MEK inhibitor at the same time works like a 1-2 punch against melanoma. The combination works better than either drug alone. Denise had that exact experience. 

Again, melanoma cells can become resistant to MEK inhibitors and the drugs have side effects, so they are usually only used in advanced Stage IV cases.  

So the bottom line for you is that you do not need either of these drugs right now. You may never need them. Since you do not have the BRAFmutation, neither Zelborf nor Tafinlar would do you any good, anyway, but the MEK inhibitor might. The immune-based treatments like ipi (Yervoy) and anti-PD1 (now in the FDA approval process) offer more promise for long-term efficacy. They are being used for Stage IV patients and sometimes for Stage III patients who are at a high risk for a recurrence. You are not there yet, either.

But if you ever have another local recurrence or if you do someday develop a distant recurrence (making you Stage IV), it is reassuring to know that both ipi and (probably) anti-PD1 will be available for you. And, if you ever need it, MEK will be available to you, too. And all of those treatments have only been available for the last 2 or 3 years, so in a way yo are lucky. (And, yes, having a "glass half full" attitude is very helpful to melanoma patients!).

Nope. No relationship that I know of. A BRAF mutation (or rather, the CORRECT BRAF mutation) only indicates whether or not you are likely to benefit from taking vemurafenib or dabrafenib.

Nope. No relationship that I know of. A BRAF mutation (or rather, the CORRECT BRAF mutation) only indicates whether or not you are likely to benefit from taking vemurafenib or dabrafenib.

Nope. No relationship that I know of. A BRAF mutation (or rather, the CORRECT BRAF mutation) only indicates whether or not you are likely to benefit from taking vemurafenib or dabrafenib.

Josh, when it's possible, surgery is always the best option for treating melanoma. If you only have one or two mets that can be surgically removed, then they are GONE! You are then considered NED. So it's good that your mets can be surgically removed. 

BRAF and MEK are two proteins that cause melanoma cells to proliferate without stopping. Theoretically,if you can inhibit those proteins, you can stop the tumors from growing and even kill the tumor cells. Unfortunately, there is no drug that can inhibit the normal (or "wild type") BRAF protein. There are, however, two drugs that can inhibit the BRAF protein if it contains a certain mutation (called the V600E,K mutation). About 50% of melanomas contain that mutation, so those patients might benefit from taking a BRAF inhibitor. Those inhibitors are called vemurafenib (trade name Zelboraf) and dabarafenib (trade name Tafinlar).

When these BRAF drugs work (in about 50% of the people who take them) they work quickly and well– shrinking tumors within a few weeks. Unfortunately, most melanoma cells eventually become resistant to the BRAF inibitors within 6-9 months, so the good effects don't last very long. And, of course, there are some nasty side effects. Therefore, the BRAF inhibitors are usually used as a short-term "emergency" meaasure in people with severe and/or rapidly spreading Stage IV melanoma. You're not nearly there, and you may never be there.

There are a couple of other inhibitors for MEK, the other proliferative protein. The one that was just recently approved by the FDA is called trametinib (tracde name Mekinist). You do not need to have any mutations to take MEK inhibitors. It does stop and/or kill melanoma in some patients, but not in as many people as the BRAF inhibitors do. What the doctors have learned over the last few years is that taking both a BRAF inhibitor and a MEK inhibitor at the same time works like a 1-2 punch against melanoma. The combination works better than either drug alone. Denise had that exact experience. 

Again, melanoma cells can become resistant to MEK inhibitors and the drugs have side effects, so they are usually only used in advanced Stage IV cases.  

So the bottom line for you is that you do not need either of these drugs right now. You may never need them. Since you do not have the BRAFmutation, neither Zelborf nor Tafinlar would do you any good, anyway, but the MEK inhibitor might. The immune-based treatments like ipi (Yervoy) and anti-PD1 (now in the FDA approval process) offer more promise for long-term efficacy. They are being used for Stage IV patients and sometimes for Stage III patients who are at a high risk for a recurrence. You are not there yet, either.

But if you ever have another local recurrence or if you do someday develop a distant recurrence (making you Stage IV), it is reassuring to know that both ipi and (probably) anti-PD1 will be available for you. And, if you ever need it, MEK will be available to you, too. And all of those treatments have only been available for the last 2 or 3 years, so in a way yo are lucky. (And, yes, having a "glass half full" attitude is very helpful to melanoma patients!).

Josh, when it's possible, surgery is always the best option for treating melanoma. If you only have one or two mets that can be surgically removed, then they are GONE! You are then considered NED. So it's good that your mets can be surgically removed. 

BRAF and MEK are two proteins that cause melanoma cells to proliferate without stopping. Theoretically,if you can inhibit those proteins, you can stop the tumors from growing and even kill the tumor cells. Unfortunately, there is no drug that can inhibit the normal (or "wild type") BRAF protein. There are, however, two drugs that can inhibit the BRAF protein if it contains a certain mutation (called the V600E,K mutation). About 50% of melanomas contain that mutation, so those patients might benefit from taking a BRAF inhibitor. Those inhibitors are called vemurafenib (trade name Zelboraf) and dabarafenib (trade name Tafinlar).

When these BRAF drugs work (in about 50% of the people who take them) they work quickly and well– shrinking tumors within a few weeks. Unfortunately, most melanoma cells eventually become resistant to the BRAF inibitors within 6-9 months, so the good effects don't last very long. And, of course, there are some nasty side effects. Therefore, the BRAF inhibitors are usually used as a short-term "emergency" meaasure in people with severe and/or rapidly spreading Stage IV melanoma. You're not nearly there, and you may never be there.

There are a couple of other inhibitors for MEK, the other proliferative protein. The one that was just recently approved by the FDA is called trametinib (tracde name Mekinist). You do not need to have any mutations to take MEK inhibitors. It does stop and/or kill melanoma in some patients, but not in as many people as the BRAF inhibitors do. What the doctors have learned over the last few years is that taking both a BRAF inhibitor and a MEK inhibitor at the same time works like a 1-2 punch against melanoma. The combination works better than either drug alone. Denise had that exact experience. 

Again, melanoma cells can become resistant to MEK inhibitors and the drugs have side effects, so they are usually only used in advanced Stage IV cases.  

So the bottom line for you is that you do not need either of these drugs right now. You may never need them. Since you do not have the BRAFmutation, neither Zelborf nor Tafinlar would do you any good, anyway, but the MEK inhibitor might. The immune-based treatments like ipi (Yervoy) and anti-PD1 (now in the FDA approval process) offer more promise for long-term efficacy. They are being used for Stage IV patients and sometimes for Stage III patients who are at a high risk for a recurrence. You are not there yet, either.

But if you ever have another local recurrence or if you do someday develop a distant recurrence (making you Stage IV), it is reassuring to know that both ipi and (probably) anti-PD1 will be available for you. And, if you ever need it, MEK will be available to you, too. And all of those treatments have only been available for the last 2 or 3 years, so in a way yo are lucky. (And, yes, having a "glass half full" attitude is very helpful to melanoma patients!).