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Metastatic melanoma is a highly challenging cancer to treat. Like other solid tumors, it is a very heterogeneous disease both clinically and biologically. Consequently, the first decision point in its management is to assess the severity of an individual patient’s disease. This can be done based on the patient’s symptoms and how they have evolved over the preceding 1-2 months, performance status, the extent of disease as determined by physical examination, and staging workup, which should include either computed tomography scans of the body or a positron emission tomography/CT study as well as a brain magnetic resonance imaging scan. Patients with brain metastases as a subset (which is sizable – 20%-25% have brain metastases) require special attention because they may not respond to systemic therapies and will thus have to be managed with brain-targeted treatment options. Tumor testing for BRAF mutations is necessary in all patients with metastatic melanoma because the BRAF inhibitors (vemurafenib or dabrafenib) are a preferred choice of targeted therapy for this subset of patients, which constitutes about 50% of all melanoma patients. Immunotherapy plays an important role in nearly all patients with metastatic melanoma including those who have progressed after anti-BRAF therapy. Chemotherapy still has a significant (yet diminishing) role for patients who are no longer suitable for immunotherapy.
Metastatic melanoma is a highly challenging cancer to treat. Like other solid tumors, it is a very heterogeneous disease both clinically and biologically. Consequently, the first decision point in its management is to assess the severity of an individual patient’s disease. This can be done based on the patient’s symptoms and how they have evolved over the preceding 1-2 months, performance status, the extent of disease as determined by physical examination, and staging workup, which should include either computed tomography scans of the body or a positron emission tomography/CT study as well as a brain magnetic resonance imaging scan. Patients with brain metastases as a subset (which is sizable – 20%-25% have brain metastases) require special attention because they may not respond to systemic therapies and will thus have to be managed with brain-targeted treatment options. Tumor testing for BRAF mutations is necessary in all patients with metastatic melanoma because the BRAF inhibitors (vemurafenib or dabrafenib) are a preferred choice of targeted therapy for this subset of patients, which constitutes about 50% of all melanoma patients. Immunotherapy plays an important role in nearly all patients with metastatic melanoma including those who have progressed after anti-BRAF therapy. Chemotherapy still has a significant (yet diminishing) role for patients who are no longer suitable for immunotherapy.
Metastatic melanoma is a highly challenging cancer to treat. Like other solid tumors, it is a very heterogeneous disease both clinically and biologically. Consequently, the first decision point in its management is to assess the severity of an individual patient’s disease. This can be done based on the patient’s symptoms and how they have evolved over the preceding 1-2 months, performance status, the extent of disease as determined by physical examination, and staging workup, which should include either computed tomography scans of the body or a positron emission tomography/CT study as well as a brain magnetic resonance imaging scan. Patients with brain metastases as a subset (which is sizable – 20%-25% have brain metastases) require special attention because they may not respond to systemic therapies and will thus have to be managed with brain-targeted treatment options. Tumor testing for BRAF mutations is necessary in all patients with metastatic melanoma because the BRAF inhibitors (vemurafenib or dabrafenib) are a preferred choice of targeted therapy for this subset of patients, which constitutes about 50% of all melanoma patients. Immunotherapy plays an important role in nearly all patients with metastatic melanoma including those who have progressed after anti-BRAF therapy. Chemotherapy still has a significant (yet diminishing) role for patients who are no longer suitable for immunotherapy.