Discussing the outcomes and prospects of the treatment

The doctor and the patient are discussing the outcomes of the treatment and the prospects. All treatment possibilities are summed up in the end.

Since 2010 the treatment options for patients with metastatic melanoma improved spectacularly, with the introduction of the treatment with BRAF/MEK inhibition and immune checkpoint inhibition. Pills that block the BRAF/MEK pathway can be given to patients with a BRAF mutation. These pills have a high chance of a tumour response within a few days, but unfortunately often resistance to this medication occurs.

The other treatment option is with immune checkpoint inhibition, such as for example ipilimumab with CTLA4 inhibition and nivolumab with PD-1 inhibition. This medication is given intravenously and it often takes weeks before a tumour response occurs. However, if there is a response, this treatment can often be stopped within a maximum of 2 years of treatment and with a high chance that the patient is cured.

In our patient with relatively small metastasis to the lung and the brain, we prefer to give immune checkpoint inhibition with ipilimumab and nivolumab, as a response in a few days is not necessary. In patients with melanoma, both treatment options are also effective for patients with brain metastasis.

How do you find the doctor’s approach in informing the patient? How would you handle a similar situation? Please share and discuss your views with other learners.