Amorphous Treatment Paradigm in Melanoma Provides Countless Options

Source: Targeted Oncology, January 2016

As new information regarding the efficacy of targeted and immunotherapeutic approaches emerge, the standard of care for patients with melanoma becomes slightly more altered.

For BRAF-positive patients with metastatic or unresectable melanoma, the standard of care includes a BRAF inhibitor with a MEK inhibitor. For patients with or without BRAF mutations, there are immunotherapeutic options in frontline and resistant disease settings. Still, questions remain on the optimal sequencing and/or combinations of both targeted agents and immunotherapies. In the same train of thought lies a question for BRAF-mutant diseases and when it is appropriate to switch from a targeted approach to an immunotherapeutic one.

Use of Immunotherapies and Sequencing in Advanced Melanoma

In December 2015, the PD-1 inhibitor pembrolizumab gained indications as a frontline treatment in patients with advanced melanoma, regardless of BRAF status, and another for patients refractory to the CTLA-4 inhibitor ipilimumab1. The FDA also recently approved the PD-1 immune checkpoint inhibitor nivolumab to include it in combination as a frontline treatment for patients with BRAF wild-type advanced melanoma.2

Jeffrey S. Weber, MD, PhD, said the “tail of the curve” with ipilimumab, nivolumab, and pembrolizumab, shows a long-lasting treatment effect with these immunotherapies.