American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with poor prognostic features and a BRAF V600 mutation, what treatment is preferred?

1. Chemotherapy with dacarbazine

2. Ipilimumab

3. High-dose interleukin-2

4. BRAF inhibitor therapy

The correct answer is: BRAF inhibitor therapy

In patients with poor prognostic features and a BRAF V600 mutation, BRAF inhibitor therapy is preferred due to its targeted mechanism of action. This type of therapy is specifically designed to inhibit the activity of the mutated BRAF protein, which plays a crucial role in the proliferation and survival of cancer cells in melanoma. By blocking this pathway, BRAF inhibitors can significantly reduce tumor growth and improve clinical outcomes in individuals with this mutation. This approach is particularly important for patients with poor prognostic features, as they are likely to benefit more from targeted therapies compared to traditional chemotherapy or immune checkpoint inhibitors. BRAF inhibitors, often combined with MEK inhibitors, have shown higher response rates and improved overall survival compared to prior standard treatments. In contrast, chemotherapy with dacarbazine generally has lower efficacy for melanoma, especially in the setting of poor prognostic features and genetic mutations like BRAF V600. Similarly, while ipilimumab (an immune checkpoint inhibitor) and high-dose interleukin-2 can be effective in certain contexts, they tend to be less effective in the specific population with BRAF mutations when compared to targeted therapies. Therefore, BRAF inhibitor therapy stands out as the preferred treatment in this scenario, promoting better outcomes for patients with these specific tumor