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NRAS Melanoma — SCE Medical Oncology MCQ

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HardMelanoma & SkinNRAS MelanomaSCE Medical Oncology

A fit patient with BRAF-wild-type metastatic melanoma progresses after nivolumab-ipilimumab, and sequencing identifies NRAS Q61R without another actionable driver. How should the NRAS result influence the next treatment discussion?

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Correct answer: B — Prioritise a trial because no approved treatment directly inhibits mutant NRAS

NRAS Q61R is biologically and prognostically relevant but has no approved direct NRAS inhibitor, so a molecular trial or genotype-independent melanoma option should be discussed. Binimetinib is a MEK inhibitor, not a direct NRAS inhibitor, and is not a routine NHS NRAS standard. Encorafenib-binimetinib requires BRAF V600 mutation. Imatinib is relevant to selected activating KIT mutations. NRAS mutation does not establish homologous-recombination deficiency for olaparib.

Reference: European consensus melanoma treatment guideline (Published December 2024): https://pubmed.ncbi.nlm.nih.gov/39709737/; NICE NG14 melanoma: recommendations (Updated July 2022; minor amendment January 2024): https://www.nice.org.uk/guidance/ng14/chapter/recommendations