A Chanced Discovery of Stage 4 Melanoma with Brain Metastasis

Without Treatment Brain Tumor revealed Tanner Deason had about 6 months to live.

Following a chance accident, Tanner Deason was diagnosed with stage 4 melanoma and a single brain metastasis in September 2020 at the age of 31. During the height of COVID, Tanner faced 3 surgeries, a single dose of radiation to his brain, immunotherapy, which he is given monthly, and targeted therapy presently. Tanner received 3 plates and 8 screws on his left cranium as a result of his emergency brain surgery.

Advance-stage melanomas tend to metastasize to three areas, the breast, lung, and brain. A brain MRI revealed a mass large enough to offset Tanner’s brain from its’ midline 3/8s of an inch, prompting an emergency, 4-hour brain surgery performed by Dr. Garni Barkhoudarian, Director and Neurosurgeon, Skull Base Microdissection Anatomy Laboratory at Pacific Neuroscience Institute.

Unbeknownst to Tanner, having no symptoms of this serious disease, the only indication of skin cancer was a dark spot located near his right collarbone, about the size of a dime. Dr. Trevan Fischer, surgical oncologist and Assistant Program Director of the Donald L. Morton Surgical Fellowship, alerted Tanner definitively that the cancer originated there.

Was it providence that Tanner had a serious UTV accident that subsequently led to the discovery of a 5/8 tumor off-setting his brain from the midline? According to Dr. Kim Margolin, medical oncologist and Medical Director of the  Melanoma, Soft Tissue, and Skin Tumor Program at Saint John’s Cancer Institute, “brain metastases are associated with a high symptom burden and are often the cause of death in advanced melanoma.”¹

Mr. Deason was fortunate to discover he had an advanced stage melanoma with brain metastases when he did. If not, he would have left behind his two small children and wife in approximately 6 months’ time, according to Dr. Barkhoudarian in Tanner’s testimonial.

The accident had shepherded Tanner to visit an orthopedic surgeon, who discovered tumors instead of tissue damage, who then referred Tanner to a lymphoma specialist that confirmed advanced-stage melanoma, and urged Tanner to choose one of three places in the nation for his specific disease type and nowhere else; Saint John’s Cancer Institute in Santa Monica, Memorial Sloan & Kettering Cancer Center in New York, or MD Anderson Cancer Center in Texas.

Tanner met his care team in September of 2020 at Providence, Saint John’s in Santa Monica, CA.

Listen to Tanner tell his Cancer Journey.

Immunotherapy and Targeted Therapy to treat Advanced Melanoma

Immunotherapy and targeted therapies have been shown to decrease cancer growth in advanced stages of melanoma with brain metastases.² Tanner was given 3 rounds of Opdivo and Yerovy, generically known as nivolumab and ipilimumab; a combination immunotherapy treatment shown to drastically improve outcomes in patients with advanced melanoma.² Opvido and Yerovy are administered intravenously.

According to Dr. Trevan Fischer, Tanner had a, “dramatic response to immunotherapy treatment,” though he experienced some side effects, which were easily managed.

As mentioned in his testimonial, Tanner remained on Opdivo monthly for one year before it was determined he needed a second surgery in November of 2021 to remove two additional lymph nodes that did not resolve. A treatment known as adjuvant therapy, and widely practiced after the surgical removal of cancer to lower recurrence.³ “Systemic treatment approaches including immunotherapy and…targeting therapies… have become increasingly important in the management of melanoma brain metastases patients…resulting in a dramatic decline in melanoma mortality from 2016 and onward,” writes Dr. Kim Margolin of Saint John’s Cancer Institute in European Society for Medical Oncology journal (ESMO) entitled, What is new on the horizon in melanoma brain metastasis?¹

On July 12, 2022, Tanner underwent a third surgery to his neck. A PET scan revealed a site likely to be cancerous after 9 months of being cancer free. Due to this recurrence, and because he showed a positive BRAF mutation (BRAF-positive melanomas tend to be more aggressive), Tanner will soon receive his first targeted therapy called Braftovi—a BRAF inhibitor.^4,5 “It was described to me as a ‘lock and key,’ it only attacks when it’s supposed to,” Tanner describes. According to the article, Immunotherapy Combination Most Effective as Initial Treatment for BRAF+ Melanoma, on cancer.gov, “blocking immune checkpoint proteins helps immune cells find and kill cancer cells.”⁶

A Multidisciplinary Approach to Cancer Care

Tanner continually sees Dr. Timothy Kristedja, a medical oncologist who specializes in hematological malignancies, and Dr. Trevan Fischer, a general surgical oncologist. Both monitor Tanner closely with regular exams and scans. “This case demonstrates our approach, proactively seeing our patients and coordinating their care with our multi-disciplinary teams,” denotes Dr. Fischer.

Dr. Trevan Fischer Assistant Professor of Surgical Oncology

Dr. Garni Barkhoudarian Associate Professor of Neurosurgery

Dr. Timothy Kristedja Medical Oncologist

Christine Boley, N.P. Nurse Practitioner

Transforming biomedical research and medicine into promising new treatments used clinically starts here at Saint John’s Cancer Institute.

Translational Immunology Research & Clinical Trials for Melanoma at Saint John’s Cancer Institute

1. Outcomes of Cutaneous Melanoma Patients Clinically Tested with DecisionDx®-Melanoma: A Prospective Registry (CONNECTION PRO) 
2. IO102-IO103 in Combination With Pembrolizumab Versus Pembrolizumab Alone in Advanced Melanoma (IOB-013 / KN-D18)
3. A Randomized Phase II, Open-label, Active-controlled, Multicenter Study Investigating the Efficacy and Safety of UV1 Vaccination in Combination with Nivolumab and Ipilimumab as First-line Treatment of Patients with Unresectable or Metastatic Melanoma (UV1-202)
4. A Phase Ib/II, Open-Label, Multicenter, Randomized Umbrella Study Evaluating The Efficacy And Safety Of Multiple Treatment Combinations In Patients With Melanoma (MORPHEUS-MELANOMA)
5. DecisionDx-Melanoma Impact on Sentinel Lymph Node Biopsy Decisions and Clinical Outcomes (DECIDE)
6. A Study to Assess Safety and Efficacy of Relatlimab With Ipilimumab in Participants With Advanced Melanoma Who Progressed on Anti-PD-1 Treatment
7. Trial With BNT111 and Cemiplimab in Combination or as Single Agents in Patients With Anti-PD1-refractory/Relapsed, Unresectable Stage III or IV Melanoma
8. Substudy 02C: Safety and Efficacy of Pembrolizumab in Combination With Investigational Agents or Pembrolizumab Alone in Participants With Stage III Melanoma Who Are Candidates for Neoadjuvant Therapy (MK-3475-02C)
9. UV1 Vaccination Plus Nivolumab and Ipilimumab in Treatment of Melanoma

References

1. What is new on the horizon in melanoma brain metastasis? – PMC (nih.gov)
2. Safety and efficacy of the combination of nivolumab plus ipilimumab in patients with melanoma and asymptomatic or symptomatic brain metastases (CheckMate 204) – PMC (nih.gov)
3. Adjuvant Treatment | Melanoma Research Foundation
4. BRAF mutation in melanoma: Definition, testing, and treatment (medicalnewstoday.com)
5. BRAF Gene and Melanoma: Back to the Future – PMC (nih.gov)
6. Immunotherapy Combination for BRAF+ Melanoma – NCI (cancer.gov)

About the Media

Saint John’s Cancer Institute Media and Marketing Development

The post A Chanced Discovery of Stage 4 Melanoma with Brain Metastasis appeared first on Saint John’s Cancer Institute Blog.