[Systemic treatment of distant metastatic malignant melanoma]

Abstract

Context: Systemic therapy of advanced metastatic malignant melanoma has been considerably changed by the approval of new drugs in recent years. The targeted therapy with the B-RAF inhibitors vemurafenib and dabrafenib achieves rapid tumor reduction but is often followed by the development of resistance in the further course of therapy. By immunotherapy with ipilimumab, on the other hand, a plateau effect becomes apparent in the survival curves.

Objective: The aim of this article is to discuss the treatment options for patients with advanced melanoma with special reference to new treatment options and substances for which approval is soon to be expected.

Methods: Treatment recommendations, taking into account the S3 guidelines on diagnosis, treatment and follow-up of melanoma and recent publications (Pubmed and manual search) are presented.

Results: In patients with B-RAF mutations, targeted therapy with the B-RAF inhibitor vemurafenib achieves response rates of 50-60 %, comparable with the B-RAF inhibitor dabrafenib, yet resistance often occurs after approximately 7 months. By immunotherapy with ipilimumab long-term survival can be achieved in approximately 20 % of patients.

Conclusion: The treatment options for patients with metastatic melanoma have considerably improved in recent years. Several highly effective substances have recently become available and the approval of more potent substances is expected this year.