Effect of vemurafenib on a V600R melanoma brain metastasis

Sirs, we read with great interest the work of Klein and colleagues who described the results of treatment with dabrafenib or vemurafenib in nine melanoma patients with a V600R mutation in BRAF. Five out six evaluable patients experienced a partial tumour response. However no volume response was seen for the brain metastases in five patients. We therefore would like to present another 64-year-old patient, with a V600R mutation who did experience effect of vemurafenib treatment on a brain metastasis. At referral to our hospital he was diagnosed 2 years earlier with primary cutaneous melanoma. He had undergone 2 months ago whole brain irradiation, 20 gray in five fractions, for a solitary cerebral metastasis, but had never received systemic anti-tumour treatment. His complaints consisted of progressive fatigue as well as neurological symptoms including dysarthria and dysphasia. He was wheelchair bound and had a paresis of his right arm. Radiological staging showed subcutaneous, mediastinal and retroperitoneal lymph node metastases, as well as lung and spleen lesions. The solitary brain metastasis compressed his left lateral ventricle and induced a midline shift. The cobas 4800 BRAF V600 Mutation Test was negative. However, sequence analysis of codon 600