Treatment beyond progression and locoregional approaches in selected patients with BRAF-mutated metastatic melanoma

Article Details

Authors
Francesco Serra, Carlotta Faverio, Angioletta Lasagna, Stefania Barruscotti, Tommaso Dominioni, Marco Benazzo, Paolo Pedrazzoli, Silvia Chiellino

Article Type
Review

DOI
10.7573/dic.2021-3-1

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Abstract

The clinical management of BRAF-mutated metastatic melanoma had an important turning point after the introduction of the targeted therapy. Despite the efficacy and good tolerability of this treatment, the development of resistance mechanisms causes disease progression. The aim of this review is to investigate the role of treatment beyond progression and locoregional approaches in BRAF-mutated metastatic melanoma and provide oncologists dealing with this malignancy a useful road map on when and why to choose this strategy.

The article is structured in the form of a narrative review reporting the most significant studies on the subject. Most of the available articles are represented by retrospective studies and case reports, leading to limitations in the final interpretations. Nevertheless, a correct analysis of the selected studies allows the drawing of some conclusions. In well-selected cases, treatment beyond progression could play an important role in the treatment sequence of patients with BRAF-mutated advanced melanoma and would seem to produce good disease control rates and positive survival outcomes. A careful evaluation of the radiological examinations and laboratory tests, based on the clinical conditions, allows the identification of which patients can benefit from this strategy. Such patients are those who, at the time of progression, have favourable features such as a lower performance status according to Eastern Cooperative Oncology Group (ECOG-PS), normal lactate dehydrogenase levels and lower disease burden. The clinical benefit is also consolidated by the addition of locoregional approaches. Locoregional approaches can include electrochemotherapy, radiotherapy or surgery, and their use provides local disease control and a better quality of life for patients.

Keywords: BRAF-mutated metastatic melanoma, locoregional approaches, targeted therapy, treatment beyond progression.

Citation: Serra F, Faverio C, Lasagna A, Barruscotti S, Dominioni T, Benazzo M, Pedrazzoli P, Chiellino S. Treatment beyond progression and locoregional approaches in selected patients with BRAF-mutated metastatic melanoma. Drugs Context. 2021;10:2021-3-1. https://doi.org/10.7573/dic.2021-3-1

Contributions: FS and SC had the project idea and took care of the writing in all its parts. CF and AL contributed to the drafting of the ‘Treatment beyond progression’ section of the article, SB took care of the ‘Introduction’ section, TD and MB contributed to the writing of ‘Locoregional approaches’ section and finally PP performed the final revision of the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/07/dic.2021-3-1-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Serra F, Faverio C, Lasagna A, Barruscotti S, Dominioni T, Benazzo M, Pedrazzoli P, Chiellino S. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified later. No commercial use without permission.

Correct attribution: Copyright © 2021 Serra F, Faverio C, Lasagna A, Barruscotti S, Dominioni T, Benazzo M, Pedrazzoli P, Chiellino S. https://doi.org/10.7573/dic.2021-3-1. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/treatment-beyond-progression-and-locoregional-approaches-in-selected-patients-with-braf-mutated-metastatic-melanoma

Correspondence: Francesco Serra, Medical Oncology Unit – IRCCS Policlinico San Matteo, 19 Viale Golgi – 27100 Pavia, Italy. Email: francesco.serra03@universitadipavia.it

Provenance: Invited; externally peer reviewed.

Submitted: 24 April 2021; Accepted: 5 July 2021; Publication date: 9 August 2021.

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