20
• Clinical Trials are strongly recommended if available
• Best Supportive Care/Hospice option can be elected at any point
IVC
High PD-L1 expression and/or
≥10 mutations/Mb TMB
BRAF
V600E
mut
present?
Palliative Cytotoxic
Chemotherapy
and/or Radiation
Y
N
N
Y
Y
N
or
or
Dabrafenib
+ Trametinib
Best Supportive
Care/Hospice
Treatment
Aggressive
Care
Desired?
Rapid BRAF
assessment (IHC,
molecular), parallel
comprehensive
genetic testing*
* Cytotoxic chemotherapy may be started as a "bridge" while awaiting genomic information or while
awaiting targeted therapy (e.g. dabrafenib and trametinib).
Figure 2. Stage IVC
