Understanding the Current Era of Metastatic Melanoma

Marc S. Ernstoff, MD, branch chief for the ImmunoOncology branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, at the National Cancer Institute, discusses metastatic melanoma and how patients may be managed.

Once melanoma spreads, the disease is known as metastatic melanoma. This type of melanoma occurs during stage 3 or stage 4.

According to Ernstoff, it's important to have one’s melanoma molecularly defined as understanding the melanoma allows the development of specific small molecules to target mutations, including BRAF, and the downstream protein, MEK.

Transcription:

0:08 | Metastatic melanoma is either stage 3 or stage 4. Stage 3 melanoma is primary melanoma with regional lymph nodes involved. Patients are managed differently than patients with stage 4 disease, which is disease that spreads beyond the regional lymph nodes. There is a subset of stage 4 disease who have oligo metastases which means that there are a small number of metastases that sometimes can be resected, in which case they are managed similarly to stage 3 patients with disease.

1:02 | In the current era, it's important to have your melanoma molecularly defined. Our current understanding is that there is a particular pathway that signals the cell to grow which is called the RAS/MAP kinase pathway. There is a specific mutation in that pathway in a gene called BRAF and if your tumor has this mutation, it turns that protein on and drives your cancer to grow. Understanding this allows the development of specific small molecules to target both the BRAF mutation as well as the downstream protein called MEK.