NCCN Guidelines for Patients® | Melanoma

43 NCCN Guidelines for Patients ® : Melanoma, 2018 4  Overview of melanoma treatments Targeted therapy Because T-VEC is derived from a herpes virus, it is generally given in a controlled hospital or clinic setting. BCG and imiquimod cream BCG ( B acillus C almette- G uérin) is a germ that activates the immune system to attack melanoma cells. It is used as a local therapy for some melanomas and is injected directly into the tumor. Imiquimod cream is another immunotherapy drug that is used as local topical therapy for melanoma. The cream is rubbed onto the surface of the tumor and causes local skin inflammation. Targeted therapy Targeted therapy drugs are designed to specifically target cancer cells. For melanoma, these drugs target the activity of a specific or unique feature of melanoma cancer cells. Genes are the instructions in cells for making new cells and controlling how cells behave. An abnormal change in these instructions— called a gene mutation—can cause cells to grow and divide out of control. Some targeted therapy drugs target a specific gene that is associated with cancer. Guide 5 lists the targeted therapy drugs used for melanoma. These drugs are used as systemic therapy. They are given as a pill that is swallowed. In the past six years, the FDA (U.S. F ood and D rug A dministration) has approved 4 new targeted therapy drugs for metastatic melanoma that cannot be surgically removed: vemurafenib, dabrafenib, trametinib, and cobimetinib. All 4 of these drugs target tumors that have a damaged BRAF gene, so they will only help if you have this type of melanoma. Vemurafenib was the first to be approved, in 2011. Then, dabrafenib and trametinib were each approved in 2013. Cobimetinib, another targeted therapy drug for melanoma, was approved in 2015. These drugs are all given as a pill that is swallowed. The combination of BRAF inhibitors (vemurafenib or dabrafenib) and MEK inhibitors (trametinib or cobimetinib) is more effective than a single drug, and so a BRAF and MEK inhibitor are usually used together. The adjuvant use of dabrafenib and trametinib may prevent recurrence following surgery in patients with lymph node involvement. Guide 5. Targeted therapy drugs as systemic therapy for melanoma Generic name Brand name (sold as) Route given Cobimetinib Cotellic ® Pill that is swallowed Dabrafenib Tafinlar ® Pill that is swallowed Imatinib mesylate Gleevec ® Pill that is swallowed Trametinib Mekinist ® Pill that is swallowed Vemurafenib Zelboraf ® Pill that is swallowed