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Management of V600E and V600K BRAF-Mutant Melanoma

  • Skin Cancer (T Ito, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The optimal management of advanced stage BRAF-mutated melanoma is widely debated and complicated by the availability of several different regimens that significantly improve outcomes but have not been directly compared. While there are many unanswered questions relevant to this patient population, the major uncertainty in current practice is the choice between BRAF/MEK inhibitors or immunotherapy for those with previously untreated metastatic or high-risk disease. Decisions regarding first line therapy should include consideration of patient preference as well as the presence of symptomatic metastatic disease and degree of comorbidity, particularly secondary to any history of severe auto-immune disorder.

BRAF/MEK inhibitors have a high response rate and rapid onset and thus can be quickly introduced when patients are symptomatic. They have also produced long-term responses in a subset of patients with more favorable prognostic indicators. In addition, impressive survival benefits have also been observed in patients with resected stage 3 disease at high risk of recurrence. On the other hand, anti-PD-1 monotherapy is associated with high rates of clinical benefit (~45% response rate in the metastatic setting) and low rates of severe toxicity. In many patients with adverse prognostic features, we use combined anti-PD-1 and anti-CTLA-4 for metastatic disease. While associated with high rates of toxicity, adverse events are largely manageable with corticosteroids and treatment cessation, in which case patients may continue to benefit even after a limited duration of treatment.

Multiple treatment options exist for patients with BRAF V600 mutant melanoma. Herein, we review the clinical data for safety and efficacy of these options.

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Authors and Affiliations

  1. Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, USA

    Alexandra M. Haugh MD & Douglas B. Johnson MD, MSCI

  2. Nashville, USA

    Douglas B. Johnson MD, MSCI

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  1. Alexandra M. Haugh MD
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Correspondence to Douglas B. Johnson MD, MSCI.

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Alexandra M. Haugh declares that she has no conflict of interest.

Douglas B. Johnson has received research funding from Bristol-Myers Squibb and Incyte Corporation; has served on advisory boards for Array BioPharma, Bristol-Myers Squibb, Incyte Corporation, Merck, and Novartis; and has received travel support from Genentech.

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Haugh, A.M., Johnson, D.B. Management of V600E and V600K BRAF-Mutant Melanoma. Curr. Treat. Options in Oncol. 20, 81 (2019). https://doi.org/10.1007/s11864-019-0680-z

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