The experience of using the combined targeted regimen vemurafenib+cobimetinib in the treatment of metastatic skin melanoma with a BRAF V600E mutation in a patient with HIV infection receiving antiretroviral therapy

Background. The presence of HIV infection is a risk factor for many malignant diseases, including skin melanoma. Given the current lack of stabilization of the incidence rates of both skin melanoma and HIV infection, the search for effective and safe methods of treatment with a combination of these diseases is of great social importance. Combination therapy with vemurafenib and cobimetinib serves as a standard of treatment and has high therapeutic potential in patients with metastatic melanoma with BRAF V600 gene mutation. The toxicity profile of the combination of vemurafenib and cobimetinib was acceptable and manageable in the framework of international clinical trials and in real oncological practice; however, the spectrum of adverse events associated with their combined use with antiretroviral drugs is currently unknown. Description of the clinical case. The clinical experience of the combined targeted regimen of vemurafenib+cobimetinib in the treatment of BRAF-positive metastatic skin melanoma in a patient with HIV infection receiving antiretroviral therapy (ARVT) is presented. The treatment was accompanied by pronounced effects of skin toxicity, which may be associated with the drug-drug interaction of targeted therapy with two ARVT drugs (ritonavir, darunavir), which are a powerful inhibitors of the CYP3A4 isoenzyme and have a narrow therapeutic potential. Nevertheless, taking into account the initial degree of melanoma extension at the time of the start of antitumor therapy, the effect obtained and the possibility of correcting toxic effects in an extremely short time, treatment with the combination of targeted drugs vemurafenib+cobimetinib is justified in the considered clinical situation. The general condition of patient is satisfactory and the effect of stabilization of the tumor process maintains after 8 months of treatment. Conclusion. Given the multifactorial nature of HIV infection and oncological diseases, as well as the potential interaction between antiretroviral and anticancer drugs, it is necessary to improve coordination of treatment and communication between oncologists and infectious disease specialists. Also, it is necessary to accumulate clinical experience of combined use of antiretroviral therapy and anticancer drugs to obtain complete information about the effectiveness and safety of treatment in this category of patients.

metastatic melanoma, BRAF V600 mutation, cobimetinib+vemurafenib combination, HIV infection, antiretroviral therapy