New therapeutical strategies in the treatment of metastatic disease.

Metastatic melanoma is a very aggressive cancer. For decades, although dacarbazine has been the standard of care as first-line therapy, new therapies have now been shown their superiority either alone or in association with dacarbazine. Ipilimumab (anti-CTLA4 monoclonal antibody) and vemurafenib (BRAF V600E inhibitor) have been recently approved by the Food and Drugs Association and European Medicine Agency for their use in metastatic melanoma patients. Other compounds targeting the MAP kinase pathway (anti-MEK, anti-ERK, other anti-BRAF) are under clinical evaluation as well as molecules targeting alternate pathways. Along with the development of these targeted agents, an initial molecular characterization of each patient melanoma has become the first step to define the best therapeutic options. The recent published data shed the light on advanced melanoma management. Herein we review the latest development of these molecules and their impact on the treatment strategy.