title: Post-operative survival following metastasectomy for patients receiving BRAF inhibitor therapy is associated with duration of pre-operative treatment and elective indication.
abstract: BACKGROUND
  Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib.
  
  
  METHODS
  A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed.
  
  
  RESULTS
  Nineteen patients underwent 21 metastasectomies including craniotomy (57%), spinal decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07).
  
  
  CONCLUSIONS
  Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control.
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: He
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Lovell
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Bee Ling
authors.initials: BL
authors.lastname: Ng
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Spillane
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Speakman
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.|Department of Surgery, University of Melbourne, Parkville, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Henderson
authors.affiliation: Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Australia.|Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Shackleton
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia.|Department of Surgery, University of Melbourne, Parkville, Australia.
authors.forename: David E
authors.initials: DE
authors.lastname: Gyorki
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D059146:Metastasectomy; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D013449:Sulfonamides / Q000627:therapeutic use*; D016019:Survival Analysis; D000077484:Vemurafenib; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D047428:Protein Kinase Inhibitors; D013449:Sulfonamides; D000077484:Vemurafenib; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: BRAF; melanoma; metastasectomy; surgery; vemurafenib