Multiple Options: How to Choose Therapy in Frontline Metastatic Melanoma

Curr Oncol Rep. 2024 Aug;26(8):915-923. doi: 10.1007/s11912-024-01547-0. Epub 2024 Jun 5.

Abstract

Purpose of review: Given the rapid development of multiple targeted and immune therapies for patients with advanced melanoma, it can be challenging to select a therapy based on currently available data. This review aims to provide an overview of frontline options for metastatic melanoma, with practical guidance for selecting a treatment regimen.

Recent findings: Recently reported data from randomized trials suggests that the majority of patients with unresectable melanoma should receive a PD-1 checkpoint inhibitor as part of their first line therapy, irrespective of BRAF mutation status. Additional data also suggests that combination immunotherapies result in improved outcomes compared to single agent, albeit at the cost of increased toxicity, though to date no biomarker exists to help guide treatment selection. As the number therapeutic options continue to grow for patients with advanced melanoma, there is likely to be a continued focus on combination strategies. Defining the optimal treatment approach in order to maximize efficacy while minimizing toxicity remains an area of active investigation.

Keywords: Brain metastases; Checkpoint inhibitors; Immunotherapy; Metastatic melanoma; PD-1.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Humans
  • Immune Checkpoint Inhibitors* / therapeutic use
  • Immunotherapy / methods
  • Melanoma* / drug therapy
  • Melanoma* / pathology
  • Neoplasm Metastasis
  • Proto-Oncogene Proteins B-raf / antagonists & inhibitors
  • Proto-Oncogene Proteins B-raf / genetics
  • Randomized Controlled Trials as Topic
  • Skin Neoplasms / drug therapy
  • Skin Neoplasms / pathology

Substances

  • Immune Checkpoint Inhibitors
  • Proto-Oncogene Proteins B-raf
  • BRAF protein, human