Treatment of Unresectable or Metastatic Cutaneous Melanoma with BRAF V600 Mutation
When cutaneous melanoma is unresectable or has metastasised and a BRAF V600 mutation is confirmed, treatment selection differs substantially from BRAF wild-type disease. The mutation status is central to which therapeutic pathways apply.
Clinical Scenario
Unresectable and/or metastatic cutaneous melanoma with a confirmed BRAF V600 mutation. Molecular confirmation of this variant directly determines eligibility for specific treatment categories not available in mutation-negative disease.
Treatment Approach (partial)
The approach in this setting involves both targeted combination therapy and immunotherapy, with the selection between them informed by prior treatment history. Complete regimen details, sequencing criteria, and decision points are available in the full protocol.
References
- For patients with BRAF mutant (V600) unresectable and/or metastatic cutaneous melanoma, one of the following treatment options should be offered as first-line therapy: nivolumab plus ipilimumab followed by nivolumab OR nivolumab plus relatlimab OR nivolumab OR pembrolizumab OR dabrafenib plus trametinib OR encorafenib plus binimetinib OR vemurafenib plus cobimetinib.
- After progression on first line anti–PD-1–based therapy, patients with BRAF mutant (V600) unresectable and/or metastatic cutaneous melanoma may be offered combination BRAF/MEK inhibitor therapy as described in recommendation 3.2.1. Similarly, those who have progressed after combination BRAF/MEK inhibitor therapy may be offered anti–PD-1–based therapy as described in recommendation 3.2.1.
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