“The NCCN Guidelines for melanoma have come a long way,” said John A. Thompson, MD, Co-Director of the Melanoma Clinic at the Seattle Cancer Care Alliance, member of the Clinical Research Division of the Fred Hutchinson Cancer Research Center, Professor of Medical Oncology at the University of Washington School of Medicine, and Vice-Chair of the NCCN Melanoma Panel. A more refined treatment approach is now possible by classifying patients with metastatic or unresectable disease according to BRAFV600E mutation status, bulk and tempo of disease, and performance status, Dr. Thompson continued. Considering the relevant patient and disease characteristics, he added, “We can put the patient on the appropriate pathway for treatment, including suggested frontline and second-line therapies.”
In the 2015 update to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma, the systemic therapy section was significantly revised by converting the “Preferred Regimens” and “Other Active Regimens” lists into algorithms for the treatment of patients with metastatic or unresectable disease according to BRAFV600 mutation status. In addition, a new “Principles of Immunotherapy and Targeted Therapy” section discusses the effectiveness of these novel treatments, with recommendations for managing related toxicities.
Importantly, the recommended systemic treatment options for metastatic or unresectable melanoma now include (depending on patient and disease characteristics) ipilimumab, dabrafenib plus trametinib, pembrolizumab, and nivolumab. The updated NCCN Guidelines for Melanoma elevate the anti-programmed death protein receptor-1 (PD-1) agents to the frontline setting for metastatic or unresectable disease. Anti-PD-1 antibodies are now suggested as options for frontline therapy, because the panel assessed that response rates are higher and toxicity is lower than with ipilimumab.
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. Long GV Stroyakovsky DL Gogas H COMBI-d: a randomized, double-blinded, phase III study comparing the combination of dabrafenib and trametinib to dabrafenib and trametinib placebo as first-line therapy in patients with unresectable or metastatic BRAF V600E/K mutation-positive cutaneous melanoma [abstract]. J Clin Oncol 2014; 32( Suppl 5): Abstract 9011.