prIME Oncology virtual melanoma eCases deliver concise interactive clinical scenarios along with data to support different decision points along the patient’s disease course. Each case covers different aspects of the treatment of patients with metastatic melanoma.
0.5 AMA PRA Category 1 Credit™
Feb 15, 2018
Feb 15, 2019
Your patient is a 77-year-old woman with melanoma who has become symptomatic with fatigue over the past three weeks. She has multiple small subcutaneous nodules on her buttocks and back that she had not noticed; however, you are able to palpate them, and she can feel a couple of things on her chest and legs that have come up over the past week. She swears that nothing was there two weeks ago.
The patient’s LDH level is 1300 U/L (normal for your lab is up to 650 U/L). MRI of the brain shows no lesions, but on CT scan you find she has multiple liver metastases, small bony metastases, and multiple lung metastases. She also has a nodule in her spleen. The patient is quite fatigued and her performance status is 1. You see in her prior physician notes that she has had stage III resected disease in her left axilla and she is BRAF mutation–positive, V600K.
Jeffrey S. Weber, MD, PhDLaura and Isaac Perlmutter Cancer Center
NYU Langone Medical Center
New York, New York, United States
The activity is designed to meet the needs of medical oncologists, nurse practitioners, physician assistants, nurses, and other healthcare professionals who treat and/or manage patients with melanoma.
After successful completion of this educational activity, participants should be able to:
- Identify recent changes to the TNM staging system in melanoma, as it relates to the management of high-risk resected and metastatic disease
- Implement optimal treatment strategies for metastatic melanoma based on patient- and disease-related factors
- Develop management strategies to ameliorate the adverse effects associated with systemic therapies used in the treatment of metastatic melanoma
Your patient is a 52-year-old man with stage IV melanoma and an enlarged 4 cm mediastinal lymph node and multiple pulmonary metastases, the largest of which is 2 cm. He also has several small lytic, punched-out bony lesions in both femurs, although none are critical, and a soft tissue mass on his left shin.
Before making a treatment decision, you order an MRI of the brain and find he has right frontal and left temporal lobe metastases that are less than 1 cm each, but are clearly visible on imaging. The patient has no symptoms from these brain metastases.
Further workup shows that the patient has BRAF mutation–positive disease and his LDH is within normal limits.
This educational activity is supported by a grant from Novartis Oncology.
prIME Oncology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
prIME Oncology designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity is provided by prIME Oncology.
Method of Participation
Links to the posttest are available at the end of the activity.
In order to receive credit, participants must successfully complete the online posttest with 75% or higher.
Disclosure of Relevant Financial Relationships
prIME Oncology assesses relevant financial relationships with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. Any potential conflicts of interest that are identified are thoroughly vetted by prIME Oncology for fairness, balance, and scientific objectivity of data, as well as patient care recommendations. prIME Oncology is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial entity.
The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interest related to the content of this activity:
Dr Weber has disclosed that he has received consulting fees from Altor, Astra Zeneca, Biond, Bristol-Myers Squibb, Celldex, CytoMx, Genentech, GSK, Merck, Novartis, and Windmil. He was an independent contractor for clinical research with AstraZeneca, Bristol-Myers Squibb, Genentech, GSK, Incyte, Merck, and Novartis. He also has a patent for a CTLA-4 biomarker by Morgh and for a PD-1 biomarker by Biodesix. He is a member on advisory committees or review panels for Altor, CytoMx, Celldex, and Windmil. He also has ownership interest in Alter, Biond, Celldex, and CytoMx. He has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in his presentation.
The employees of prIME Oncology have disclosed:
- Ronald Viggiani, MD (medical director content reviewer/planner) – no relevant financial relationships
- Elizabeth Cameron, PhD (scientific content reviewer/planner) – no relevant financial relationships
- Jessica Mastrodomenico, MPH (editorial content reviewer) – no relevant financial relationships
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Disclosure Regarding Unlabeled Use
This activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration or European Medicines Agency. Please refer to the official prescribing information for each product discussed for discussions of approved indications, contraindications, and warnings.