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New Melanoma Therapies
There has been a phenomenal revolution in the management of metastatic melanoma (stage 4) in the last five years. Dermatologists, skin cancer doctors and other clinicians who manage skin cancer in their day-to-day work must be aware of new melanoma therapies and advances in the management of metastatic melanoma. They should also be aware of cutaneous adverse side effects of new treatments to better manage patients with metastatic melanoma.
Previously, metastatic melanoma had a poor prognosis, but advances in management have dramatically
improved the outlook for patients. Two main approaches have been taken.
Targeted melanoma therapies including vemurafenib have demonstrated a 50 per cent clinical response and 90 per cent disease control if the patient is positive for BRAF mutation (which is seen in 50 per cent of melanomas).
Resistance to BRAF-inhibitors (such as vemurafenib) may develop within 12 months. This led to combination therapy with MEK-inhibitors, such as trametinib. It is now possible to profile mutations in melanoma, allowing a new classification of melanomas by mutation profile (“melanoma genomics”). This may guide more personalised treatment for melanoma in the future.
Immunotherapy (inhibition of immune checkpoints) is “taking the breaks off the immune system” to fight melanoma. Ipilimumab is the first immunotherapy drug that prolonged survival against melanoma. Pembrolizumab and nivolumab are newer immunotherapy drugs.
Targeted therapy can also be combined with immunotherapy. However, with these new drugs comes a whole new range of cutaneous adverse reactions, further challenging the skills of the clinician.
Alani, R. & Swetter, S. Melanoma – New Therapies. 76th American Academy of Dermatology (AAD) Annual Meeting 2018 Conference Review. February 2018. Page 2.