Approaches to metastatic skin melanoma therapy in 2020: a dynamic way forward
The choice of first-line therapy for metastatic skin melanoma has become quite a difficult task in the last few years: a practicing oncologist has got drugs of different classes with different mechanisms of action - immune checkpoint blockers and BRAF/MEK tyrosine kinase inhibitors. In this study, the authors have tried to systematize their own experience and current scientific information about the treatment of patients with metastatic skin melanoma in the first and subsequent lines of therapy. The paper discusses the importance of correct initial assessment of the patient’s condition and prevalence of the process, the role of currently available biomarkers in metastatic skin melanoma, as well as the effectiveness and safety of possible first-line therapy options for this disease. Due to the lack of data for direct comparison of combined immunotherapy, combined targeted therapy, triple combination of BRAFi + MEKi + aPDl1 blockers and aPD1 monotherapy obtained from randomized studies, we have to draw parallels between studies with different diagnoses and different patient populations. Since the practicing oncologist has to do the same thing in his or her daily work, we believe that our review will be very useful for these doctors. The article also discusses the possibility of using drug therapy in the second and subsequent lines and a successful strategy to return to previous treatment in some cases. The clinical observation of a patient with metastatic foot skin melanoma, which has been observed in our department since 2010, is given as an illustration of the success of sequential treatment tactics with different drugs. Clinical observation shows the success of returning to some previously used therapy lines, including after the progression on them.