Bayesian Analysis of a Patient with either Recurrent Metastatic Melanoma or Ipilimumab-Induced Sarcoidosis

The decision to use Ipilimumab was partly influenced by the patients young age, therefore checkpoint inhibitors, such as Ipilimumab, may have durable complete responses (approximately 20% for Ipilimumab in metastatic melanoma). These durable complete responses are likely to emerge as the equivalent to a cure. Though drugs such as Vemurafenib or even combined BRAF and MEK inhibitors can improve progression free survival and overall survival, they do not have this effect. It is likely that melanoma is more aggressive in patients with BRAF mutant melanoma progressing on a BRAF inhibitor [1]. Therefore conceptually it is possible that one could deny this young patient the opportunity of curative checkpoint inhibitor treatment with first line BRAF inhibition as post progression he may have a declining performance status. In addition, the kinetics of clinical benefit of Ipilimumab is delayed so the patient could die from progressive disease prior to benefit emerging [1].