Table 3.

A case for consideration: personalizing the care of a 73-year-old woman with metastatic melanoma

Biologic personalized therapeutics

Mrs. M is a 73-year-old woman with metastatic melanoma with multiple pleural masses and genomics revealing an actionable B-RAF V600E mutation indicating that the disease is amenable to treatment with vemurafenib.

Other dimensions of personalizing medical care

Mrs. M is a 73-year old-widow who lives alone in a third-floor walk-up apartment. She has metastatic melanoma with multiple pleural masses that are complicated by moderate to severe chronic pain and dyspnea on exertion. Controlled release morphine tablets are providing only partial and inadequate relief of her pain, and she is distressed by constipation. She has a daughter who is able to help her on weekends. She is anxious about her future and fearful about the prospects of severe pain or suffocation at the end of life. She is aware that her disease is incurable and that her anticipated life expectancy is limited. She is interested in life-prolonging treatment but only if it has minimal risk of side effects. She is a pensioner with limited financial resources and her insurance has a 25% copayment on medications.