Extreme elevation of acute phase reactants and shock secondary to dabrafenib-trametinib

Area of Science:

• Oncology
• Pharmacology

Background:

• Targeted therapies like BRAF and MEK inhibitors represent advancements in treating advanced melanoma with BRAF mutations.
• These treatments, while effective, can present unique toxicities, such as pyrexia (fever), which may be unfamiliar to clinicians.

Observation:

• A patient with stage IV melanoma (BRAF Val600E mutated) experienced recurrent severe fever, hypotension, and elevated acute phase reactants within three months of initiating dabrafenib and trametinib.
• These episodes, initially treated as septic shock, occurred without evidence of infection.

Findings:

• Withholding dabrafenib and trametinib temporarily managed the episodes.
• Subsequent dose reduction of dabrafenib led to the resolution of fever episodes, indicating a likely drug-induced toxicity.

Implications:

• This case highlights the importance of recognizing and managing pyrexia associated with BRAF and MEK inhibitors in melanoma patients.
• Dose adjustment of targeted therapy may be a viable strategy to mitigate severe drug-related toxicities, improving patient tolerance and treatment adherence.