Title:The Genetic Basis of New Treatment Modalities in Melanoma
Volume: 16
Issue: 3
Author(s): Manfred Kunz
Affiliation:
Keywords:
BRAF, genetics, immunotherapy, targeted treatment.
Abstract: In recent years, intracellular signal transduction via RAS-RAF-MEK-ERK has been successfully
targeted in new treatment approaches for melanoma using small molecule inhibitors against
activated BRAF (V600E mutation) and activated MEK1/2. Also mutated c-KIT has been identified as
a promising target. Meanwhile, evidence has been provided that combinations between BRAF inhibitors
and MEK1/2 inhibitors are more promising than single-agent treatments. Moreover, new treatment
algorithms favor sequential treatment using BRAF inhibitors and newly developed immunotherapies
targeting common T lymphocyte antigen 4 (CTLA-4) or programmed cell death 1 (PD-1). In
depth molecular analyses have uncovered new mechanisms of treatment resistance and recurrence, which may impact on
future treatment decisions. Moreover, next-generation sequencing data have shown that recurrent lesions harbor specific
genetic aberrations. At the same time, high throughput sequencing studies of melanoma unraveled a series of new treatment
candidates for future treatment approaches such as ERBB4, GRIN2A, GRM3, and RAC1. More recent bioinformatic
technologies provided genetic evidence for extensive tumor heterogeneity and tumor clonality of solid tumors, which
might also be of relevance for melanoma. However, these technologies have not yet been applied to this tumor. In this review,
an overview on the genetic basis of current treatment of melanoma, treatment resistance and recurrences including
new treatment perspectives based on recent high-throughput sequencing data is provided. Moreover, future aspects of individualized
treatment based on each patient’s individual mutational landscape are discussed.
