Treatment for Stage IV

Over the past decade, significant advancements have been made in the treatment for advanced melanoma with improved efficacy and toxicity profiles compared to earlier immunotherapies and chemotherapy. Targeted therapy involves the use of small molecule inhibitors designed to block oncogenic pathways such as the MAPK pathway. Immune checkpoint inhibitor therapy takes advantage of the immune sensitivity of melanoma cells by removing the brake that promotes tolerance to tumor cells. There have also been several studies demonstrating improved effect with combination therapy. This chapter discusses the evidence supporting the use of targeted therapy and immune checkpoint inhibitor therapy for advanced and metastatic melanoma.