Biomarkers, targeted and immunotherapies for melanoma

This section covers the following topics:

• Immunotherapy
• Tumor biomarker testing for treatment selection
• Targeted therapy

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