Dabrafenil and Trametinib (Dab/Tram) and low WBCs/Neutrophils
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Dabrafenil and Trametinib (Dab/Tram) and low WBCs/Neutrophils

› Forums › General Melanoma Community › Dabrafenil and Trametinib (Dab/Tram) and low WBCs/Neutrophils

  • Post
    • March 15, 2020 at 3:09 pm
    eouellet
    Participant
      Hello Everyone,

      I am taking Dab/Tram for Adjuvant therapy (recurrent melanoma in 2 left axillary lymph nodes (January 2020), after the removal of melanoma on my left back with negative margins and negative sentinel node biopsy in Nov 2018)

      I am experiencing a grade 3/4 side effect: low White Blood Cells and Low Neutrophils (which occurred after 10 days of the first dosing). After stopping the medication for 5 days, they (WBCs and Neutrophils) returned to normal quickly. After restarting a second time, the same happened after 8 days but not as severe. I stayed on the medication for an additional 4 days with the same lab results, but no further decrease in my counts. THEN…the infamous fever, chills, aches presented that evening and next day. My Oncologist advised me to stop the medications again (perfectly makes sense). I am going to see him Monday (3/16/2020) to discuss. In a brief discussion Friday on the phone he mentioned discussing immunotherapy.

      I have the BRAF + mutation melanoma for which BRAF and MEK-1 inhibitors are indicated for treatment. I also understand these medication are newly FDA approved and Neutropenia (low WBCs + Neutrophils) only occurred in 11% of the patients who participated in the trials of this combination treatment. I cannot find any information regarding the attempts to manage this side effect.

      Has anyone experienced this side effect (low WBCs and Neutrophils? How did your oncologist help you manage it? I really want to try dose adjustment (as done with fever, chills, aches)…or if this is chronic, try taking filgrastim (Neulasta) to enhance WBC production? I feel like because there is limited information about the long-term management of the side effect I am experiencing, I want to give it a little longer and see if this side effect might subside as described with other side effects (fever, chills, aches.) I have no other serious side effects related to organ toxicity; heart, lung, liver, kidneys, bleeding, skin.

      Any information would be helpful.
      Thank you,
      Edie

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    • Replies
        • March 15, 2020 at 4:36 pm
        Bubbles
        Participant
          Sorry for the difficulties you have been dealing with in regard to melanoma generally and your targeted therapy in particular, Edie.

          First of all, for those of us who have been in melanoma world for a long time – yes, it seems as though FDA approval of current melanoma therapies – both targeted and immunotherapy – is very new indeed as neither targeted nor immunotherapy as we now know them were available before 2011. However, targeted therapy (which we have learned should almost always consist of a BRAF inhibitor combined with a MEK inhibitor – and there a few of both) has been around since 2011 with the first, Vemurafenib (zelboraf) being approved that year. The drugs you are currently taking have been FDA approved for use in melanoma patients since 2013. Here is the approval time line for Mekinist (trametinib): https://www.drugs.com/history/mekinist.html Here is the approval time line for Tafinlar (dabrafinib): https://www.drugs.com/history/tafinlar.html

          All that to say, that researchers and oncologists have been learning about how to dose and manage melanoma patients on targeted therapy since basically 2011 and a bit before as these drugs were in trials with melanoma patients before their approval. So, that is really good news for folks who are in need of these medications now. Because of all that data, we have lots of information that you and your doc needs today. Here is a report from 2017 that addresses a lot of your questions about how to manage side effects related to targeted therapy: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/05/management-of-adverse-events-with.html

          It is also true that FDA approval of targeted therapy as ADJUVANT in melanoma (mostly Stage III patients) is a newer situation, and as you can see from the approval time line, the drugs you are taking were approved for THAT purpose in 2018. However, the knowledge already accrued still serves everyone in good stead. (Clearly, these approval dates can add one more layer of confusion for patients. If you are interested you can look at my response along the same issue but in regard to immunotherapy in this thread: https://melanoma.org/legacy/find-support/patient-community/mpip-melanoma-patients-information-page/nodular-melanoma-stage-iib)

          As far as data and info regarding the use of targeted therapy as adjuvant in melanoma – here are lots of reports that you may find interesting: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=adjuvant+targeted+therapy

          I hope all that makes sense. I hope the information helps. It is very common to have to manage targeted therapy side effects with dosage adjustments, drug holidays, and steroids. I’m sure others will chime in with their experiences and your doc will get your side effects under control. Ask more questions as you have the need. I wish you my best. Celeste

            • March 15, 2020 at 4:52 pm
            Bubbles
            Participant
              One other thought. If you truly cannot tolerate targeted therapy as your treatment due to unmanageable side effects, you could always talk to your doc to switching to immunotherapy as adjuvant. Here are lots of articles on adjuvant treatment in melanoma generally: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=adjuvant

              c

              • March 15, 2020 at 9:48 pm
              eouellet
              Participant
                Thank you for your post. Yes, That is what I am going to discuss (immunotherapy) with my onc tomorrow. I wanted to see if anyone overcame initial havoc with dab/tram and neutropenia before switching.
                • March 15, 2020 at 9:48 pm
                eouellet
                Participant
                  Thank you for your post. Yes, That is what I am going to discuss (immunotherapy) with my onc tomorrow. I wanted to see if anyone overcame initial havoc with dab/tram and neutropenia before switching.
                  • March 15, 2020 at 10:42 pm
                  eouellet
                  Participant
                    Thank you for your reply. I am especially interested in the ctDNA bloodwork that can detect melanoma tumor cells in the blood. I wonder how often this is used as a diagnostic tool to determine treatment plans?
                    • March 15, 2020 at 11:22 pm
                    Bubbles
                    Participant
                      I am very interested in that as well, and have been writing (and ranting!!! HA!) about it for years!!! I think ctDNA monitoring it is very promising and important for melanoma patients for many reasons. Such a test can be used to diagnosis melanoma patients, impact therapy choice, measure response to that therapy, and monitor how well that response is maintained. Here are a zillion reports: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=ctdna Unfortunately it is far from standard of care and not routinely available to most melanoma patients. However, I would definitely ask my oncologist about it!!!! c
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