Abstract
There have been significant advances in the treatment of malignant melanoma with the U.S. Food and Drug Administration approval of two drugs in 2011, the first drugs approved in 13 years. The developments of immune checkpoint modulation via cytotoxic T-lymphocyte antigen-4 blockade, with ipilimumab, and targeting of BRAF(V600), with vemurafenib or dabrafenib, as well as MEK, with trametinib, have been paradigm changing both for melanoma clinical practice and for oncology therapeutic development. These advancements, however, reveal new clinical questions regarding combinations and optimal sequencing of these agents in patients with BRAF mutant disease. We review the development of these agents, putative biomarkers, and resistance mechanisms relevant to their use, and possibilities for sequencing and combining these agents.
Keywords:
BRAF; Biomarker; CTLA-4; Immunotherapy; MEK; Resistance.
Publication types
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Research Support, Non-U.S. Gov't
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Review
MeSH terms
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Antibodies, Monoclonal / administration & dosage
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Antineoplastic Combined Chemotherapy Protocols
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Drug Resistance, Neoplasm
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Drug Synergism*
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Humans
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Imidazoles / administration & dosage
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Indoles / administration & dosage
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Ipilimumab
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MAP Kinase Kinase Kinases / antagonists & inhibitors
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MAP Kinase Kinase Kinases / genetics
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Melanoma / drug therapy*
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Melanoma / genetics*
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Melanoma / pathology
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Mutation
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Oximes / administration & dosage
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Proto-Oncogene Proteins B-raf / antagonists & inhibitors
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Proto-Oncogene Proteins B-raf / genetics*
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Pyridones / administration & dosage
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Pyrimidinones / administration & dosage
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Sulfonamides / administration & dosage
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Vemurafenib
Substances
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Antibodies, Monoclonal
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Imidazoles
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Indoles
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Ipilimumab
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Oximes
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Pyridones
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Pyrimidinones
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Sulfonamides
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Vemurafenib
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trametinib
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BRAF protein, human
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Proto-Oncogene Proteins B-raf
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MAP Kinase Kinase Kinases
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dabrafenib