Fast Five Quiz: Metastatic Melanoma Treatment

Winston W. Tan, MD, FACP


May 24, 2023

In advanced melanoma, patients who show progression > 6 months after adjuvant treatment can be retreated using the same agent or treated with an alternative agent class. With required resistance to BRAF inhibitors, targeted therapy may be continued with isolated disease progression via a locoregional approach. Though long-term benefit is not expected, patients with acquired resistance in the metastatic setting may benefit from BRAF-directed retreatment. While prospective studies are needed, current retrospective data suggest that treatment with BRAF inhibitors beyond progression is associated with improved survival.

Moreover, ESMO guidelines report that acquired resistance mechanisms to BRAF inhibition can be reversible after treatment interruption. BRAF inhibitor rechallenge in patients who previously progressed on targeted therapies was associated with up to 50% objective response rate and a 4-5-month median progression-free survival. Most of these patients were initially treated with BRAF inhibitor monotherapy and received combination BRAF/MEK inhibition as rechallenge.

Similarly, NCCN guidelines advise that some patients who demonstrated a clinical benefit to BRAF/MEK inhibition may also benefit from rechallenge with BRAF/MEK inhibitors after other therapies.

Learn more about BRAF inhibitors.


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