The plan is to try and get Steve in for a biopsy sometime next week to be sure that the tumor has the same BRAF mutation as the adrenal tumor had. Typically, if one tumor has the mutation, then all tumors will have the same mutation. However, Dr. Kim would like to be sure. However, Dr. Kim also does not want to wait a long time to get treatment started, so if Steve does not have a biopsy scheduled next week, he will start Zelboraf. Zelboraf is one of the newer approved drugs approved by the FDA. It was approved in August of 2011 and targets the BRAF mutation. You can read more about Zelboraf here http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0041057/
Zelboraf is an oral medication. A total of 8 pills taken per day. He will take the pills for 8 weeks and then go back in for scans. We did discuss the possibility of removing the lymph node by surgery in 6-8 months if Steve stays clear of any other tumors. The thinking on whether or not to do surgery on a Stage IV patient is basically that if you have melanoma in a lymph node and another organ in your body (the adrenal gland that was removed) that the melanoma has already entered your blood stream and there is a higher likelihood of new tumors popping up. That is why Dr. Kim wants to wait 6-8 months to be sure no other tumors pop up before jumping into another surgery.
While this is a bit discouraging to us, we are staying optimistic. It is fantastic that there are no new tumors. Zelboraf is a great drug and should be able to knock this lymph tumor out. There are some side effects to the medicine (not as harsh as the biochemo though). Hopefully Steve will be able to continue to work in the office during this treatment and if not, at least work from home.
Tomorrow Steve has to have some additional lab work drawn and have an EKG to make sure his heart is still healthy enough for the Zelboraf.
Tomorrow is also a big day for us!! We have been invited to a major press conference at MD Anderson starting at 10am. MD Anderson will be announcing the 5 cancers they have chosen to focus their "Moon Shot" program on. We are excited to be able to attend and excited that melanoma may be one of these cancers!