Targeted therapy

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Targeted Therapy

If your melanoma is found to have a faulty BRAF gene or a BRAF mutation when it is sent for genetic testing, then targeted therapy is a potential treatment option for you. Approximately 40 to 50% of patients are found to have this mutation. BRAF inhibitor treatments have not been shown to work unless you have the faulty BRAF gene or mutation.

If your melanoma does have the faulty gene, then it may be described as BRAF positive. If your melanoma doesnt have a faulty gene, then your melanoma may be described as BRAF negative or wild type. This mutation is not something that is inherited and so cannot be passed to your children.  

melanoma

Understanding targeted therapies  

Dr Elaine Vickers, Cancer Science Communicator, explains BRAF and MEK targeted therapies in this video.

 A BRAF inhibitor (dabrafenib/encorafenib/vemurafenib) is given in combination with a MEK inhibitor (trametinib/binimetinib/cobimetinib). You will have read or been told that dabrafenib is given with trametinib and that encorafenib is given with binimetinib and these are all targeted treatments. They are tablets and capsules which are taken daily at home.

Targeted treatment can be used to treat melanomas:

  1. That cannot be removed by surgery
  2. That have spread to other parts of the body. Dabrafenib and trametinib or encorafenib and binimetinib are treatment options and treatment is continued until the treatment doesn’t work or unacceptable side effects occur.
  3. After surgery if the melanoma has only spread to the nearby area or lymph nodes and the surgeon was able to remove all of the melanoma. This treatment is called adjuvant treatment and it is given to help reduce the risk of the melanoma coming back.  In this instance, dabrafenib and trametinib are given for up to a year.  For more information on adjuvant treatment see here

Possible side effects

All cancer therapies are associated with some side effects that may impact on daily life to a lesser or greater extent.  Early treatment of side effects can help manage them better and it is therefore important to let your medical team know if you experience anything unusual for you. Not everyone will experience side effects and many of the side effects are temporary so can improve after treatment is paused.

The first part of this side effect section gives you information on common side effects of all targeted treatments and then following this, there is information on some common side effects relating to dabrafenib and trametinib and then encorafenib and binimetinib. 

Some common side effects of targeted treatments

High temperature (fever) and chills (shivering)

These can be side effects of treatment, or also can be signs of infection. If you feel generally unwell while you are on treatment let your medical team know.

Being sick (vomiting) or feeling sick (nausea)

If you feel sick or are being sick while on treatment, medicines can be given to help control this. It is important if you are being sick to drink lots of fluids to stop you from becoming dehydrated.  If you are not able to take drink, let your medical team know as soon as you are able.

Diarrhoea or constipation

Some people may experience diarrhoea or constipation while on treatment and medicines can be given to help control this. It is important if you do have diarrhoea to drink lots of fluids to stop you from becoming dehydrated.  If you have diarrhoea more than 4 times a day, or if you think you are losing more fluid in diarrhoea than you can replace by drinking, let your medical team know as soon as you are able.

High blood pressure

You will have your blood pressure checked regularly by the medical team while you are on treatment.

Liver problems

You will have regular blood tests while on treatment and the medical team will monitor your liver function closely.

Eye problems

Some minor eye problems can occur commonly, however less occasionally it can be the sign of a more serious side effect, therefore it is important to contact your medical team immediately if you get any of these symptoms: eye redness and irritation, blurred vision, eye pain, loss of vision, increased sensitivity to light, floating spots before the eyes, shadows or halo’s (blurred outline around objects).

Pain in the arms, legs or joints

You may experience pain in different parts of the body such as the arms or legs or joints. If you do feel pain in different parts of your body, painkillers can be used to control this. It could also be a sign of a more serious problem so make sure to tell your medical team if you get any unusual pains.

Muscle pain

Muscle pain, weakness or spasms can be a common side effect with this treatment. They could also be the sign of a more serious side effect called rhabdomyolysis, so it is important to report this to your medical team immediately.

Bleeding problems

Mild bleeding can be common, but the treatment can very occasionally cause serious bleeding problems in different parts of the body. Therefore, it is important to call your medical team right away if you have any unusual signs of bleeding, including coughing up of blood, vomit containing blood or that looks like “coffee grounds”, red or black poo that look like tar, passing blood in the urine or unusual vaginal bleeding.

Some other common side effects can be:

Headaches and dizziness, tiredness and weakness (fatigue), loss of appetite, hair thinning, muscle spasms

Some other common side effects of dabrafenib and trametinib

Changes in your skin

This treatment combination can cause skin changes such as rash or acne-like rash or soreness and/or redness on the palms and soles of the feet. These can be treated with creams or medicines to make them manageable. The treatment can also cause more serious skin reactions and so it’s important to report all skin changes to your medical team.

Cough or shortness of breath

It is important to report any symptoms such as shortness of breath or cough to your medical team.  These are common side effects but sometimes it could be the sign of a more serious inflammation in the lungs.

Some other common side effects of encorafenib and binimetinib

Low red blood cells (aneamia)

You will have regular blood tests while on treatment and the medical team will monitor your red blood cell count closely. If you feel breathlessness or look unusually pale while you are on treatment, let your medical team know as this may be a sign of a low red blood cell count.

Numbness or tingling in fingers and toes

Some people may feel a burning or shooting pain. It is important to let your medical team know, especially if it becomes more painful, you find you’re losing your balance or if you’re struggling to do fiddly tasks with your hands like doing up buttons.

Changes in your skin

When taking this treatment, you may notice skin changes including a rash, dry skin, itching, and your skin might feel thicker. These can be treated with creams or medicines to make them more manageable.

Your skin might also be more sensitive to the sun and at risk of severe sunburn. As always, it’s recommended to wear a high-factor, broad-spectrum sunscreen and cover up when out in the sun.

Swelling of the hands and legs

Swelling of the hands and legs can occur due to a build-up of fluid (oedema). Contact your medical team should you experience these symptoms.

Trouble Sleeping (insomnia)

Sometimes you might notice you find it hard to sleep while taking this treatment. If it is becoming really difficult let your medical team know.

Pain in your back or tummy

These can be a common side effect with this treatment and painkillers can be used to control this. It could also be a sign of a more serious problem so make sure to tell your medical team if you do get any unusual pains.

If you have any worries or concerns, please contact your medical team or call our:

Melanoma Helpline on 0808 801 0777

There may be clinical trials looking at new treatments to treat your type of melanoma.  For more information on clinical trials see the Melanoma TrialFinder

Questions you may have

  • Does my melanoma have the faulty BRAF gene or is BRAF positive?
  • What are my treatment options?
  • How frequently will I have treatment?
  • What are the potential side-effects and what should I do if I experience anything unusual?
  • What clinical trials are potential options for me?
  • When will I know if the targeted therapy treatment has been successful?

Relevant References:

Cancer Research UK, Dabrafenib and trametinib https://www.cancerresearchuk.org/about-cancer/treatment/drugs/dabrafenib-trametinib  [Accessed 2023]

Cancer Research UK, Encorafenib and binimetinib https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/encorafenib-binimetinib  [Accessed 2023]

Electronic Medicines Compendium, https://www.medicines.org.uk/emc/product/9501/pil [Accessed 2023]

Electronic Medicines Compendium, https://www.medicines.org.uk/emc/product/9499/pil [Accessed 2023]

Electronic Medicines Compendium, https://www.medicines.org.uk/emc/product/5190/pil [Accessed 2023]

Electronic Medicines Compendium, https://www.medicines.org.uk/emc/product/7792/pil [Accessed 2023]