First line treatment of BRAF mutated advanced melanoma: does one size fit all?
Cette étude passe en revue les différentes stratégies thérapeutiques de première ligne chez des patients atteints d'un mélanome de stade avancé et présentant une mutation BRAF
In the last decade, immunotherapy and target therapy have revolutionized the prognosisof patients with BRAF-V600 mutation-positive metastatic melanoma. To date, three different combinationsof BRAF/MEK inhibitors have been approved for this population, showing comparable efficacy andunique toxicity profiles. Several immune-checkpoint inhibitors, including pembrolizumab,nivolumab and the combination of nivolumab plus ipilimumab, are also available optionsfor untreated metastatic melanoma patients. A novel approach has emerged by combiningimmune-checkpoint inhibitors and targeted agents, based on preclinical hints of synergy,prompting clinical results from large randomized trials. Specifically, the tripletof atezolizumab, vemurafenib and cobimetinib has been recently approved by FDA forpatients with untreated BRAF-mutant metastatic melanoma. With a wide variety of available treatment options inthis setting, it is paramount to establish criteria to select the most effective andsafe frontline tailored approaches, for each patient. Results from ongoing studiesare awaited, to maximise the benefits in survival outcomes and quality of life forpatients, balancing adverse events and clinical benefit. The purpose of this reviewis to summarize the current landscape of standard and experimental treatment strategiesfor the first line treatment of patients with BRAF-mutated advanced melanoma and discuss the best patient-centered tailored strategiesin the first-line setting.