Metastatic melanoma is a common cancer in Australia, with BRAF gene mutations present in 40% of cutaneous melanomas. Therapies for metastatic melanoma have rapidly evolved over the past decade and include targeted molecular therapies and immunotherapies. Although these therapies greatly improve patient outcomes, they have unique toxicity profiles and the treating oncologist, in discussion with the patient, is best placed to manage these.
- Targeted therapy and immunotherapy have significantly improved survival for advanced melanoma since 2010.
- Testing for a BRAF gene mutation is now standard practice in advanced melanoma to guide therapeutic decision-making.
- If advanced melanoma is BRAF mutation positive, targeted therapy with combination BRAF/MEK inhibitors is an effective therapeutic option, either as first- or second-line therapy.
- Immunotherapies that inhibit immune checkpoints can also be used to treat advanced melanoma.
- Immunotherapies significantly improve survival and may lead to enduring disease control for a proportion of patients.
- Toxicities with targeted therapies are predictable.
- Immune-related toxicities from immunotherapy are unpredictable and require a high index of suspicion, particularly within the first three to four months of starting treatment.
- The treating medical oncologist should always be involved in managing therapy-induced toxicities.