What are the recommendations for second-line treatments of advanced or metastatic melanoma?

Updated: May 05, 2020
  • Author: Winston W Tan, MD, FACP; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

Stage IV [14, 15, 16, 17, 18, 19, 20] :

  • Clinical trial is preferred

  • Pembrolizumab 200 mg IV q3wk or 400 mg q6wk until disease progression or unacceptable toxicity; it is indicated as first-line treatment for unresectable or metastatic malignant melanoma; note that the trial used a higher dose of pembrolizumab than the dose approved by the FDA, which is 2 mg/kg q3wk  [21]  or

  • Ipilimumab 3 mg/kg IV over 90 min; q21 d for a total of four doses [22] or

  • Dacarbazine 2-4.5 mg/kg/day IV for 10 days; may repeat q4wk; or  250 mg/m2 IV on days 1-5; may repeat q3wk or

  • Temozolomide 150 mg/m2 PO on days 1-5; repeat q28 days; may increase dose to 200 mg/m2 PO on days 1-5 or

  • Interleukin-2 600,000 U/kg IV q8h (maximum 14 doses); following nine days of rest, repeat for another 14 doses (not to exceed 28 doses per course, as tolerated; FDA-approved recommendation) or

  • Nivolumab 240 mg IV q2wk or 480 mg IV q4wk over 30 min until disease progression or unacceptable toxicity; single agent in the first-line treatment of unresectable or metastatic BRAF V600 wild-type or mutation-positive melanoma [13]

  • Vemurafenib 960 mg PO q12h (for patients with BRAF V600E mutation); not indicated for wild-type BRAF melanoma

  • Dabrafenib 150 mg PO BID (for BRAF V600E mutation); not indicated for wild-type BRAF melanoma

  • Trametinib 2 mg PO qd (for BRAF V600E or V600K mutations); not indicated in patients who have received prior BRAF inhibitor therapy

  • Imatinib 400 mg PO qDay (for activating KIT mutations) [2, 23]

  • Larotrectinib 100 mg PO BID until disease progression or until unacceptable toxicity (for NTRK gene fusions) [24]

  • Entrectinib 600 mg PO BID until disease progression or until unacceptable toxicity (for NTRK gene fusions) [25]

  • Binimetinib 45 mg PO BID until disease progression or until unacceptable toxicity (for NRAS mutations) [26]


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