Therapy for metastatic melanoma: the past, present, and future

Abstract

Metastatic melanoma is the most aggressive form of skin cancer with a median overall survival of less than one year. Advancements in our understanding of how melanoma evades the immune system as well as the recognition that melanoma is a molecularly heterogeneous disease have led to major improvements in the treatment of patients with metastatic melanoma. In 2011, the US Food and Drug Administration (FDA) approved two novel therapies for advanced melanoma: a BRAF inhibitor, vemurafenib, and an immune stimulatory agent, ipilimumab. The success of these agents has injected excitement and hope into patients and clinicians and, while these therapies have their limitations, they will likely provide excellent building blocks for the next generation of therapies. In this review we will discuss the advantages and limitations of the two new approved agents, current clinical trials designed to overcome these limitations, and future clinical trials that we feel hold the most promise.

Figure 1

Typical response for patients on BRAF inhibitors. BRAF inhibitors can induce positron emission tomography (PET) responses in as little as two weeks but unfortunately most patients developed relapse and progressive disease at about six months. This patient was treated in the phase 1 study of PLX4032 (vermurafenib).