Reply To: Fevers

[Suzanne McGettigan]

Hi All–
I do agree with Kathy that the majority of fevers from dabrafenib/trametinib do tend be in the 101-103 range–luckily not too many over 104, but these certainly are possible.

There was a publication recently from the Australian Melanoma group which delineates their management strategies for pyrexia. This management guide is definitely more in line with my practice.
I will include a link to it here: https://doi.org/10.1111/ajco.12656

In this guideline, patients would hold both dabrafenib and trametinib with onset of fever > 100.5 degrees Farenheit. They would initiate anti-pyretic agents (acetominophen, NSAIDs) as well other supportive care measures (adequate hydration). They could resume both agents once fever free and asymptomatic for at least 24-48 hours. However, if symptoms do not improve within 24 hours, they would be instructed to initiate corticosteroid (i.e. prednisone 10-25 mg daily) as an anti-inflammatory to reduce fever and to continue as prophylaxis against pyrexia/pyrexia syndrome with resumption of dabrafenib/trametinib. The corticosteroid dose could be tapered after approximately one month if the patient remained fever-free.

I would certainly be interested in how you all manage these as well.
thanks,
suzanne