Immunotherapy and Targeted Therapy in Patients With Advanced Melanoma and the V600 BRAF Mutation: Which One First?

Abstract

Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.

Keywords: Adjuvant treatment; Anti-CTLA4; Anti-PD1; BRAF inhibitors; BRAF-MEK inhibitors; CTLA4 inhibitors; Immunotherapy; Inhibidores de BRAF; Inhibidores de BRAF-MEK; Inmunoterapia; Melanoma; Neoadjuvant therapy; PD1 inhibitors; Targeted therapy; Terapias dirigidas; Tratamiento adyuvante; Tratamiento neoadyuvante.