Adjuvant Treatment with Targeted Therapy

[Anonymous]

With the approval of targeted therapies in the adjuvant setting on the horizon, I’ve heard several express concern about patients developing resistance early on and recurring with a vengeance. From my experience with these drugs in the metastatic setting, when patients progressed, they oftentimes did so with a vengeance. What are your thoughts about this?

[Samantha Guild]

We really haven’t used it in the adjuvant setting as of yet. We are treating patients mainly either in a adjuvant clinical trial or with Nivolumab. What I found intersting in the adjuvant BRAF study is was there was a higher incidence of pyrexia compared to the metastatic studies. The Pyrexia can really affect patients quality of life which makes it difficult to justify in the adjuvant setting.

[Anonymous]

I totally agree! Pyrexia can be a huge challenge, notably when it is recurrent or resistant to corticosteroids.

[Anonymous]

Mollie, I agree with your concern about recurrence and rapid disease progression after use of BRAF targeted therapies in the adjuvant setting (which we have not starting doing yet). It will be interesting to see if this pattern emerges from the data as it matures. And the side effects can be quite debilitating for some patients.

[Anonymous]

True – the side effects are a separate issue. It will be interesting to see which oncologists prefer in the BRAF mutant population. The good news is that we at least have options beyond interferon!!

[Author]

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