Abstract
Metastatic melanoma is very aggressive tumor with high mortality. Recognition of significance of BRAF V600E mutation and identification of immune checkpoints made it possible to introduce new treatment modalities.
The targeted therapy with BRAF and MEK inhibitors and immunotherapy blocking the CTLA-4 and PD-1 receptors markedly increase objective response rate and prolong progression free survival and overall survival in patients with metastatic melanoma. Even higher effectiveness is seen in combined treatment with ipilimumab plus nivolumab or pembrolizumab; the same is true for combined targeted therapy with BRAF and MEK inhibitors but, particularly in combined immunotherapy, at a cost of higher toxicity.
In the near future, we have to determine the optimal dosing and timing of particular treatment options