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WCCS/EADO 2016 | The future of tyrosine kinase inhibitors for melanoma and open questions

Axel Hauschild, MD, PhD of University Hospital Schleswig-Holstein, Kiel, Germany, gives an overview of his talk on the future of tyrosine kinase inhibiton for melanoma at the 2016 World Congress on Cancers of the Skin (WCCS) and the Congress of the European Association of Dermato-Oncology (EADO) in Vienna, Austria. There are several studies on the way on the question of how to treat patients. One idea is to treat patients intermittently in order to delay the development of resistance or even completely avoid it. Another question is how the treatment schedules can be optimized and if another tyrosine kinase inhibitor can be added (and further if it should be an ERK inhibitor or an inhibitor of the PI3K-Akt pathway). According to Prof. Hauschild, studies on this are underway but it seems that there are issues with tolerability, i.e. it is not easy to give another tyrosine kinase inhibitor for a triple regiment. It is possible to add one after the other as Prof. Hauschild describes it, i.e. when patients respond to treatment with dabrafenib and tremetinib or vemurafenib and cobimetinib, you can step in with, for example, immunotherapy or PD-1 antibodies. Then, if the patient shows progressive disease again, it is possible to give the tyrosine kinase inhibitors again. It has been shown that the drugs work again. The last option is to give three at once, i.e. BRAF plus MEK inhibitor and a PD-1 antibody. This works and is tolerable according to Prof. Hauschild. The burning question for the future concerns combinational approaches and sequential treatment.

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