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Successful Rechallenge with Vemurafenib and Corticosteroids in a Patient with Vemurafenib Induced Liver Dysfunction, Previously Treated with Ipilimumab

Kyle Phillip Radack, Keisuke Shirai

Abstract


Introduction: There are multiple new systemic therapies for patients with metastatic melanoma, including vemurafenib and ipilimumab. Because of this, more patients will be exposed to multiple medicines during their treatment course. Here we present the case of a successful rechallenge with vemurafenib and concurrent corticosteroids in a patient with vemurafenib responsive metastatic melanoma and vemurafenib induced liver dysfunction thought to be related to previous treatment of ipilimumab.

Presentation of case: A 60-year-old woman with a history of stage 3 melanoma presented with metastases to her liver and lymph nodes, normal liver function tests (LFTs) and was started on ipilimumab. After her symptoms increased and her disease progressed, ipilimumab treatment was stopped and vemurafenib was initiated. She experienced good regression in her disease burden but subsequently experienced a grade 4 elevation in her LFTs, which resolved with a corticosteroid taper. Her disease responded well to a vemurafenib rechallenge at a reduced dose; however, she experienced another increase in her LFTs.  By administering vemurafenib with corticosteroids concurrently, she achieved good tumor shrinkage without liver dysfunction.

Conclusion: The reader should have an increased appreciation for the emerging adverse event profile of patients treated with multiple systemic metastatic melanoma therapies during their course and potential management strategies.


Keywords


Melanoma; Vemurafenib; Ipilimumab; Corticosteroids; Hepatotoxicity

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References


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