Risk Management & Treatment

Biomarkers, targeted and immunotherapies for melanoma

This section covers the following topics:


Immunotherapy

Immunotherapy helps the body’s immune system to fight cancer. Two types of immunotherapies are commonly used to treat advanced stage melanoma: 

  • Immune checkpoint inhibitors are a type of immunotherapy used to treat melanoma. These include:
    • Keytruda (pembrolizumab)
    • Opdivo (nivolumab)
    • Yervoy (ipilumumab)
      • Sometimes Yervoy is used in combination with Opdivo
  • Imlygic (talimogene laherparepvec or T-VEC therapy) is a genetically engineered virus that is used to treat advanced melanoma. The medication is injected directly into the tumor to stimulate an immune response.  


Biomarker testing for treatment selection

Biomarker tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:

  • how fast the cancer is growing
  • which treatments are most likely to work
  • whether or not the cancer is responding to treatment or growing
  • whether or not the cancer has come back after remission

Biomarker tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. Biomarker tests used to select a specific treatment are sometimes called companion diagnostic tests. These tests may be done on tumor tissue or on blood. See our Biomarker Testing section for more information. 

Experts recommend that patients with advanced or recurrent melanoma also be tested for the following biomarkers:

  • Tumor biomarker testing can find a specific mutation in a gene known as BRAF.  In melanoma, the most common BRAF mutation is called V600E (may also be V600K/R/M/D/G).  Patients with a BRAF V600 mutation may benefit from the addition of targeted therapies known as BRAF inhibitors.

Additional biomarker tests that may be used for melanoma:

  • Tumor biomarker testing can find mutations in genes known as KIT and NRAS.
  • Biomarker testing may help identify people who are eligible for certain clinical trials.


Targeted therapy

Target therapies for melanoma include:

  • BRAF inhibitors
    • BRAF inhibitors are oral medications that help slow down tumor growth in patients with advanced or recurrent melanoma that test positive for the tumor biomarker called a BRAF V600 mutation.
    • About half of all melanomas have a tumor mutation in the BRAF gene.
    • If your melanoma has a BRAF mutation often you will get both a BRAF inhibitor and a MEK inhibitor. Combining these drugs often works better than either one alone.
    • BRAF inhibitors include:
      • Tafinlar (dabrafenib)
      • Braftovi (encorafenib)
      • Zelboraf (vemurafenib)
  • MEK inhibitors
    • MEK inhibitors are oral medications that are given alone or in combination with a BRAF inhibitor to treat melanoma in people with a BRAF V600 mutation.
    • MEK inhibitors include:
      • Mekinist (trametinib)
      • Cotellic (cobimetinib)
      • Mektovi (binimetinib)


Table of targeted and immunotherapies for melanoma

Name of drug Type of agent Cancer stage Indication Biomarker
Braftovi
(encorafenib)
BRAF inhibitor (type of kinase inhibitor) Unresectable or metastatic melanoma

Combined with Mektovi (binimetinib), for the treatment of patients with unresectable or metastatic melanoma

BRAF V600E or V600K tumor mutation
Cotellic
(cobimetinib)
BRAF inhibitor (type of kinase inhibitor) Unresectable or metastatic melanoma Combined with Zelboraf (vemurafenib) for the treatment of patients with unresectable or metastatic melanoma  BRAF V600E or V600K tumor mutation
Mekinist (trametinib) MEK inhibitor
(type of kinase inhibitor)
Melanoma Combined with Taflinar (dabrafenib) as adjuvant treatment of patients with melanoma and involvement of lymph node(s), following complete resection BRAF V600E or V600K tumor mutation
Mekinist (trametinib) MEK inhibitor
(type of kinase inhibitor)
Unresectable or metastatic melanoma As a single agent and in combination with dabrafenib for the treatment of unresectable or metastatic melanoma  BRAF V600E or V600K tumor mutation
Mektovi (binimetinib MEK inhibitor
(type of kinase inhibitor)
Unresectable or metastatic melanoma Combined with Braftovi (encorafenib), for the treatment of patients with unresectable or metastatic melanoma  BRAF V600E or V600K tumor mutation
Tafinlar
(dabrafenib)
BRAF inhibitor (type of kinase inhibitor) Unresectable or metastatic melanoma Combined with Mekinist (trametinib) for the treatment of patients with unresectable or metastatic melanoma  BRAF V600E or V600K tumor mutation
Tafinlar
(dabrafenib
BRAF inhibitor (type of kinase inhibitor) Unresectable or metastatic melanoma Combined with Mekinist (trametinib) for the treatment of patients with unresectable or metastatic melanoma  BRAF V600E or V600K tumor mutation
Tafinlar
(dabrafenib
BRAF inhibitor (type of kinase inhibitor) Melanoma Combined with Mekinist (trametinib) as adjuvant treatment of patients with melanoma and involvement of lymph node(s), following complete resection BRAF V600E or V600K tumor mutation
Keytruda (pembrolizumab) Immune checkpoint inhibitor Metastatic or unresectable melanoma For the treatment of patients with metastatic melanoma No biomarker required
Keytruda (pembrolizumab) Immune checkpoint inhibitor Melanoma For the adjuvant treatment of patients with involvement of lymph node(s) following complete resection No biomarker required
Opdivo 
(nivolumab) 
Immune checkpoint inhibitor Metastatic or unresectable melanoma As a single agent or combined with ipilimumab No biomarker required
Opdivo 
(nivolumab)
Immune checkpoint inhibitor Metastatic or lymph node positive melanoma For the adjuvant treatment of patients following complete resection No biomarker required
Yervoy (ipilumumab) Immune checkpoint inhibitor Metastatic or unresectable melanoma For the treatment of patients with metastatic melanoma No biomarker required
Yervoy (ipilumumab) Immune checkpoint inhibitor Melanoma Adjuvant treatment of patients with cutaneous melanoma with pathologic involvement of regional lymph nodes of more than 1 mm who have undergone complete resection, including total lymphadenectomy No biomarker required
Imlygic (T-VEC or talimogene laherparepvec) Cancer vaccine Unresectable recurrent melanoma For local treatment of cutaneous, subcutaneous, and nodal lesions in patients with melanoma recurrent after initial surgery No biomarker required
paying-for-service

The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply. Patient costs and coverage for specific doctors, facilities or treatments may vary based on your health plan. Visit our section on Insurance and Paying for Care: Treatment  for more information, links to sample appeal letters and other resources. 

Some pharmaceutical companies and laboratories have assistance programs that help cover the cost for their medications, tumor testing or genetic testing for an inherited mutation: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Needy Meds: Assistance programs to help patients with cost of medications and other healthcare.
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.