BRAF-Mutant Melanoma — RACP Adult Medicine MCQ

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ModerateMedical OncologyBRAF-Mutant MelanomaRACP Adult Medicine

A 70-year-old man with metastatic melanoma (BRAF V600E mutant) has progressive disease on pembrolizumab. What is the most appropriate next-line systemic therapy?

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Correct answer: D — Dabrafenib + trametinib (BRAF/MEK inhibitor combination)

For BRAF V600E-mutant metastatic melanoma progressing on anti-PD-1 therapy, targeted therapy with combined BRAF + MEK inhibition (dabrafenib + trametinib or encorafenib + binimetinib) is the recommended next-line treatment. Response rates are ~65–70% with rapid onset. Combined ipilimumab + nivolumab is an alternative if not previously tried. The sequencing of immunotherapy and targeted therapy depends on disease tempo, tumour burden, and prior treatments.

Reference: Cancer Council Australia – 2020 – Melanoma Clinical Practice Guidelines; PBS – 2025