Binimetinib y edema macular quístico: un dilema terapéutico en los pacientes con melanoma metastásico

Abstract

We present the case of a woman with metastatic BRAF-mutated melanoma and a history of type 1 diabetes mellitus, who developed ocular toxicity secondary to binimetinib treatment. She was initially treated with vemurafenib and cobimetinib, achieving complete remission. However, due to cumulative toxicities, therapy was switched to encorafenib and binimetinib in February 2023. After three months, she developed cystoid macular edema (CME), confirmed by optical coherence tomography (OCT). Management included binimetinib dose reduction and topical ketorolac, resulting in initial improvement, although the CME recurred several months later. The rapid progression of metastatic melanoma in January 2024, with peritoneal carcinomatosis, massive ascites, and a left adrenal metastasis, limited further treatment options such as intravitreal anti-VEGF or dexamethasone. The patient ultimately began immunotherapy with nivolumab and ipilimumab, but died in February 2024 due to refractory abdominal septic shock. This case highlights the importance of early ophthalmologic monitoring and interdisciplinary collaboration in patients receiving MEK inhibitors.