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KIT-mutant Mucosal Melanoma — SCE Medical Oncology MCQ

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HardMelanoma & SkinKIT-mutant Mucosal MelanomaSCE Medical Oncology

Metastatic mucosal melanoma progresses after checkpoint therapy. Sequencing shows a KIT exon 11 L576P mutation rather than KIT amplification alone, and no BRAF V600 mutation. If off-label or trial access is available, which kinase inhibitor has the most established mutation-selected phase II evidence?

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Correct answer: C — Imatinib after confirmation of the sensitising KIT mutation

Imatinib has the most established prospective mutation-selected evidence in mucosal, acral and chronically sun-damaged melanoma, with sensitising KIT mutation a stronger predictor than amplification alone. Nilotinib has limited later-study activity but is not the best-established answer. Sunitinib evidence is smaller and less definitive. Dasatinib has not become the preferred mutation-selected approach. Ripretinib is established in gastrointestinal stromal tumour rather than as the standard KIT-mutant melanoma option.

Reference: Phase II imatinib study in KIT-altered mucosal, acral and chronically sun-damaged melanoma (Published September 2013): https://pubmed.ncbi.nlm.nih.gov/23775962/; NICE NG14 melanoma: recommendations (Updated July 2022; minor amendment January 2024): https://www.nice.org.uk/guidance/ng14/chapter/recommendations