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Managing Melanoma in the Era of Molecular Testing and Targeted Therapy: A Q&A With Ragini Kudchadkar, MD

Jason M. Broderick
Published Online: Tuesday, October 29, 2013
Dr. Ragini Kudchadkar

Ragini Kudchadkar, MD

Molecular testing and novel therapies have revolutionized the management of metastatic melanoma in recent years. A review of the latest clinical developments was presented at the recent Physicians’ Education Resource meeting, Update for Clinicians on Diagnosis and Treatment of Melanoma and Other Cutaneous Malignancies. The meeting was held on September 28, 2013, at the Moffitt Cancer Center in Tampa, Florida. For insight on the evolving treatment landscape in melanoma, Oncology & Biotech News sat down with one of the expert presenters, Ragini Kudchadkar, MD, a medical oncologist in the Department of Cutaneous Oncology at Moffitt Cancer Center, and an assistant professor at the University of South Florida College of Medicine’s Department of Oncologic Sciences.

Oncology & Biotech News: What is the current approach to molecular testing in melanoma?

Dr. Ragini Kudchadkar: Outside of clinical trials, the testing that needs to be done is for patients who have a chance at targeted therapy. I think that BRAF mutational status is primarily the test that’s being done, and it’s being done primarily in stage IV disease. However, most of us believe that for a very high-risk patient with stage IIIc disease it’s reasonable to test them, as their risk of reoccurrence is very high, and in some populations almost 70% will reoccur. Many people get frustrated at the delay when it can take a week, even 2 weeks to get test results back, and when you have a metastatic patient who is sick, it’s nice to know upfront. However, I would not recommend testing patients with very early-stage disease who are likely to be cured with surgery alone.

Game Changers: Novel Agents for the Treatment of Advanced Melanoma

Agent Trade Name Mechanism Approval Date
ipilimumab Yervoy anti-CTLA-4 antibody March 25, 2011
vemurafenib Zelboraf BRAF inhibitor August 17, 2011
dabrafenib Tafinlar BRAF inhibitor May 29, 2013
trametinib Mekinist MEK inhibitor May 29, 2013
dabrafenib + trametinib Tafinlar/ Mekinist BRAF/MEK inhibitor January 8/9, 2014 Action Date on FDA Priority Review
Ipilimumab and vemurafenib have both been approved in the last two years. How has this changed clinical practice and treatment outcomes for patients with metastatic melanoma?

With melanoma, it’s a whole different ballgame now where people have multiple different options and you’re able to tailor the options depending on their goals of therapy, depending on quality of life, and Managing Melanoma in the Era of Molecular Testing and Targeted Therapy A Q&A With Ragini Kudchadkar, MD depending on symptomatology from their disease. It also means there are more and more patients who are long-term survivors. Melanoma used to be a universally fatal disease, and now we have more and more patients where it’s becoming a chronic disease, where they’re seeing us in follow-up but they’re living years with their disease. It has just really changed the landscape of melanoma and given patients a lot more options.

The BRAF inhibitor dabrafenib and the MEK inhibitor trametinib were approved as single agents and combination use of the drugs is being evaluated under the FDA’s priority review program. What is the therapeutic rationale for combined BRAF/MEK inhibition?

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