Drug treatment for melanoma: progress, but who pays?

In reply: The letters of Morgan and Fullerton correctly emphasise the importance of palliative care in the management of patients with metastatic melanoma. They also draw attention to the immense cost of new drugs for melanoma, and their limited efficacy in life extension — something I also emphasised.1 Much ignored in this debate is the rapid and dramatic improvement in quality of life experienced by nearly all melanoma patients on BRAF inhibitors,2 an example of where medical oncology and palliative care should, and must, work hand in hand in optimising patient comfort. We strive toward this goal in our multidisciplinary teams. However, it is in the adjuvant setting that the new antimelanoma drugs are likely to show large improvements in survival and where reimbursement of drug costs will become an increasing challenge.