I think we are more likely to give immunotherapy adjuvantly. The side affects of dabrafenib especially the pyrexia are very difficult for patients to maintain their normal lifestyle. I think that dabrafenib and tramatenib do have a place adjuvantly with patients who can’t recieve immunotherapy such as those with precious history of colitis or other autoimmune conditions or organ transplant patients.
such a great question. I agree with Rajni. The oral targeted therapies are very challenging for many patients. There will definitely be a select group of patients in which these agents are used in the adjuvant setting, but the pyrexia and febrile syndrome make them quite challenging in more advanced melanoma patients.
I also agree with you all. I think that providers will start with IO unless it is contraindicated (pre-existing autoimmune disease, etc.). Plus, we all know how horribly the disease “explodes” once resistant to BRAF therapy. It will be interesting to see how it plays out, though.