Optimal treatment strategy for metastatic melanoma patients harboring BRAF-V600 mutations

Emilio Francesco Giunta, Vincenzo De Falco, Stefania Napolitano, Giuseppe Argenziano, Gabriella Brancaccio, Elvira Moscarella, Davide Ciardiello, Fortunato Ciardiello, Teresa Troiani, Emilio Francesco Giunta, Vincenzo De Falco, Stefania Napolitano, Giuseppe Argenziano, Gabriella Brancaccio, Elvira Moscarella, Davide Ciardiello, Fortunato Ciardiello, Teresa Troiani

Abstract

BRAF-V600 mutations occur in approximately 50% of patients with metastatic melanoma. Immune-checkpoint inhibitors and targeted therapies are both active as first-line treatments in these patients regardless of their mechanisms of action and toxicities. However, an upfront therapeutic strategy is still controversial. In fact, waiting for results of ongoing clinical trials and for new biomarkers, clinicians should base their decision on the clinical characteristics of the patient and on the biological aspects of the tumor. This review provides an overview on BRAF-V600 mutations in melanoma and will discuss their prognostic and clinical significance. Moreover, it will suggest a therapeutic algorithm that can drive therapeutic choice in a first-line setting for BRAF-V600 mutant melanoma patients.

Keywords: BRAF-V600 mutations; immunotherapy; metastatic melanoma; prognostic biomarker; targeted therapy.

Conflict of interest statement

Conflict of interest statement: Teresa Troiani: Institutional research grants: Roche, Merck, Sanofi, Servier, Novartis, Bayer. Fortunato Ciardiello: Advisory boards: Roche, Amgen, Merck, Pfizer, Sanofi, Bayer, Servier, BMS, Cellgene Lilly. Institutional research grants: Bayer, Roche, Merck, Amgen, AstraZeneca, Takeda. The remaining authors have no conflicts of interest to declare

© The Author(s), 2020.

Figures

Figure 1.
Figure 1.
Proposed algorithm for first-line treatment choice in untreatedBRAF-V600 mutant metastatic melanoma patients. BRAFi, BRAF inhibitor; LDH, serum lactate dehydrogenase; MEKi, MEK inhibitor; SLD, sum of lesion diameters.

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