Current and emerging treatments in skin cancer

The authors aimed to highlight current treatment options available for skin cancer patients

Melanoma is a complex cancer due to the number of cell mutations (changes to normal cells and their function)  that can occur. Melanoma mutations can include BRAF (responsible for activating  cell growth and function) and N-RAS (controls cell growth and function) mutations. 40-60% of melanoma patients have BRAF mutated cancer and 15-25% have N-RAS mutations. While surgery is the main treatment in early-stage cancer, recurrent or metastatic cancer (cancer that has spread from the original site) is often unresectable (not treatable with surgery). In these cases, the cancer is often treated with chemotherapy including dacarbazine (DTIC).

The aim of this study was to highlight available treatments for skin cancer patients.

In BRAF mutated skin cancer vemurafenib (Zelboraf – BRAF inhibitor) is a common drug used with good progression-free survival (patient has not experienced cancer recurrence since treatment), overall survival (patients who did not die from skin cancer following treatment) and mild to moderate side-effects (fatigue, rashes or joint pain). However drug resistance occurred in nearly 50% of patients and cancer typically progressed within 6 months when vemurafenib was used as a single drug treatment.

Fotemustine (Muphoran – chemotherapy drug) showed positive effects in melanoma patients with brain tumors where the average survival time was 22.7 months compared to 7.2 months in patients treated with dacarbazine. Dabrafenib (Tafinlar – inhibits cancer growth) was approved as a safe and effective single-drug treatment for melanoma patients with brain tumors and with BRAF mutations, where the average overall survival was 13 months with mild to moderate side-effects (joint pain, thickening of outer skin layer and fever).

Trametinib (Mekinist – oral BRAF inhibitor) as a single treatment option showed success in BRAF mutated skin cancer patients, with 5.7 month progression-free survival, good patient response and minor side-effects experienced (diarrhea and rashes). Combining trametinib and dabrafenib resulted in an improved progression-free survival of 9.3 months and a 67% overall response to treatment compared to patients who did not receive this treatment. Combining selumetinib (AZD6244) and dacarbazine also significantly improved progression-free survival (5.6 months) compared to 3 months in patients who did not receive combination treatment.

Binimetinib (MEK 162) treatment resulted in well-tolerated side effects in patients with both N-RAS and BRAF mutations and had a positive patient response to treatment. Dabrafenib and trametinib have been approved as treatment for advanced melanoma and showed an average overall survival of 27.4 months compared to patients who did not receive dabrafenib and trametinib treatment. Both imatinib (Glivec) and nilotinib (Tasigna) showed significant effects against tumors and manageable side-effects in studies involving patients with c-KIT (involved in cell growth) mutated melanoma.

The authors conclude that though there are numerous drugs emerging in melanoma treatment further studies are required to determine safety and function in patients.

This study included results from various experiments which may not have been conducted in the same way, affecting overall results.

If you have concerns regarding melanoma treatment options available, please consult your doctor for potential risks and benefits.