title: MEK inhibitors and their potential in the treatment of advanced melanoma: the advantages of combination therapy.
abstract: The treatment of melanoma has improved markedly over the last several years with the advent of more targeted therapies. Unfortunately, complex compensation mechanisms, such as those of the mitogen-activated protein kinase (MAPK) pathway, have limited the clinical benefit of these treatments. Recently, a better understanding of melanoma resistance mechanisms has given way to intelligently designed multidrug regimes. Herein, we review the extensive pathways of BRAF inhibitor (vemurafenib and dabrafenib) resistance. We also review the advantages of dual therapy, including the addition of an MEK inhibitor (cobimetinib or trametinib), which has proven to increase progression-free survival when compared to BRAF inhibitor monotherapy. Finally, this review touches on future treatment strategies that are being developed for advanced melanoma, including the possibility of triple therapy with immune checkpoint inhibitors and the work on optimizing sequential therapy.
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Khiem A
authors.initials: KA
authors.lastname: Tran
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: Cheng
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Anupam
authors.initials: A
authors.lastname: Mitra
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Vivian Y
authors.initials: VY
authors.lastname: Shi
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Olney
authors.affiliation: Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE, USA.
authors.forename: April M
authors.initials: AM
authors.lastname: Kloxin
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Emanual
authors.initials: E
authors.lastname: Maverakis
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D020929:Mitogen-Activated Protein Kinase Kinases / Q000037:antagonists & inhibitors; D058990:Molecular Targeted Therapy; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D047428:Protein Kinase Inhibitors; D020929:Mitogen-Activated Protein Kinase Kinases
keywords: BRAF inhibitor; MAPK pathway; cobimetinib; dabrafenib; trametinib; vemurafenib