العلاج الخطي الأول للورم الميلانيني الجلدي غير القابل للاستئصال في المرحلة الثالثة أو الرابعة مع طفرة BRAF V600

References

DOI: 10.1016/j.annonc.2024.11.006

• For patients with unresectable disease, first-line ipilimumabenivolumab [ESMO-MCBS v1.1 score: A/4] is a preferred option for all patients regardless of BRAF status when this can be safely delivered for the first few months (i.e. when a rapid response is not required due to aggressive/symptomatic disease) [I, A].
• First-line nivolumab [I, A; ESMO-MCBS v1.1 score: A/4] or pembrolizumab [I, A; ESMO-MCBS v1.1 score: A/4] is also recommended.
• If anti-PD-1-based therapy is not available or patients are considered ineligible for its use, BRAFieMEKi combination therapy (dabrafenibetrametinib [ESMO-MCBS v1.1 score: 5]; vemurafenibecobimetinib [ESMO-MCBS v1.1 score: A/5]; binimetinibeencorafenib [ESMO-MCBS v1.1 score: A/5]) is also an option in the first line for patients with BRAF-mutated melanoma [I; A; ESCAT score: I-A].
• For patients in whom the decision to treat with targeted therapy has been made, those who cannot receive a MEKi (e.g. due to cardiovascular comorbidities, a recent BM bleeding event, history of retinal detachment or other ophthalmological contraindications) can be offered encorafenib as monotherapy [II, B; not FDA or EMA approved].