Medikamentöse systemtherapie des melanoms

Context. Around 3000 melanoma patients are diagnosed with metastatic disease each year in Germany. For more than three decades no substantial therapeutic progress in the treatment of advanced melanoma was made; however, the use of targeted agents and immune modulating antibodies has changed the perception of melanoma as treatment-resistant tumor. Objective. The aim of this article is to discuss the systemic treatment options for advanced metastatic melanoma. Material and methods. Treatment recommendations are given in consideration of the S3 guidelines on diagnosis, therapy and follow-up of melanoma published in 2013 and other recent publications (PubMed and manual search). The Results. CTLA-4 blocking antibody, ipilimumab, was the first medication to demonstrate an overall survival benefit in a prospective randomized clinical study of metastatic melanoma. Subsequently selective BRAF as well as MEK inhibitors were also shown to prolong overall survival leading to drug registration. Currently additional agents and antibodies, such as MEK inhibitors for NRAS mutations in melanoma and PD1 blocking antibodies are being tested in clinical phase III studies. Over the next years the combination and sequence of these new agents will further improve the treatment and prognosis of advanced melanoma. Treatment of metastatic melanoma always requires a multidisciplinary approach. Conclusion. Therapy options for patients suffering from advanced metastatic melanoma have improved in recent years. Nevertheless, clinical studies still remain the best option to improve melanoma treatment and to offer patients innovative and promising treatment options despite the recently achieved progress.