Ipilimumab,
an anti-CTLA-4 monoclonal antibody, has been shown to improve overall survival
in patients with metastatic melanoma. Preliminary data suggest that patients
who fail BRAF inhibitor treatment experience a very rapid progression of
disease. Such selectivity for more rapid disease progression may mean these
patients do not receive the same benefit from subsequent treatment with
ipilimumab as patients without prior BRAF inhibitor treatment. The current
challenge is focused on how to identify and approach the two populations of
fast and slow progressors and recent hypothesis suggest that treatment choice
could be guided by baseline risk factors. However, no data have yet defined
which the best sequence is and more research is needed to identify predictors
of response in patients with metastatic melanoma to help guide whether a BRAF
inhibitor or ipilimumab should be used first in sequential therapy.
Source: Do BRAF inhibitors select for populations with
different disease progression kinetics? Ascierto PA (paolo.ascierto@gmail.com), Simeone
E, Grimaldi AM, Curvietto M, Esposito A, Palmieri G, Mozzillo N. J Transl Med.
2013 Mar 8;11:61.
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