Management of Patients With Advanced Melanoma

Presenter: Genevieve Boland

For treatment of melanoma, accumulated research has allowed the transition of the most effective treatments into earlier stages of disease management. To this end, immunotherapy has become approved for high-risk stage II and resected stage III melanoma, and is currently being evaluated in the neoadjuvant setting. BRAF/MEK-targeted therapy is also approved in the adjuvant setting and is being evaluated in neoadjuvant trials. In stage IV disease, the optimal sequencing of these 2 main approaches is with immunotherapy initiated first. Recently, the LAG-3 antibody relatlimab, in combination with nivolumab, has produced impressive responses with low toxicity and has become a new standard of care compared with anti–PD-1 monotherapy. As heterogeneity within disease stages has become better appreciated, staging and risk classification have been refined.

Disclosures: Dr. Boland has disclosed receiving grant/research support from InterVenn Biosciences, Olink Proteomics, Palleon Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc.; and serving as a scientific advisor for Ankyra Therapeutics, InterVenn Biosciences, Iovance Pharmaceuticals, Merck & Co., Inc., Nektar Therapeutics, and Novartis Pharmaceuticals Corporation.

Correspondence: Genevieve Boland, MD, PhD, Massachusetts General Hospital, 55 Fruit Street, Jackson 9, Boston, MA 02114. Email: gmboland@mgh.harvard.edu
  • 1.

    Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual, 8th edition. New York, NY: Springer Cham; 2017.

  • 2.

    Morton DL, Thompson FJ, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 2014;370:599609.

  • 3.

    Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 2017;376:22112222.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Korn EL, Liu PY, Lee SJ, et al. Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials. J Clin Oncol 2008;26:527534.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Ugurel S, Röhmel J, Ascierto PA, et al. Survival of patients with advanced metastatic melanoma: the impact of novel therapies-update 2017. Eur J Cancer 2017;83:247257.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med 2017;377:18241835.

  • 7.

    Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma (EORTC 1325-MG/KEYNOTE-054): distant metastasis-free survival results from a double-blind, randomised, controlled, phase 3 trial. Lancet Oncol 2021;22:643654.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Luke JJ, Rutkowski P, Queirolo P, et al. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage IIB or IIC melanoma (KEYNOTE-716): a randomised, double-blind, phase 3 trial [published online March 31, 2022]. Lancet, doi: 10.1016/S0140-6736(22)00562-1

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Long GV, Hauschild A, Santinami M, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med 2017;377:18131823.

  • 10.

    Blank CU, Rozeman EA, Fanchi LF, et al. Neoadjuvant versus adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma. Nat Med 2018;24:16551661.

  • 11.

    Rozeman EA, Reijers ILM, Hoefsmit EP, et al. Twenty-four months RFS and updated toxicity data from OpACIN-neo: a study to identify the optimal dosing schedule of neoadjuvant ipilimumab and nivolumab in stage III melanoma [abstract]. J Clin Oncol 2020;38(Suppl):Abstract 10015.

    • Search Google Scholar
    • Export Citation
  • 12.

    Blank CU, Reijers ILM, Pennington T, et al. First safety and efficacy results of PRADO: a phase II study of personalized response-driven surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in resectable stage III melanoma [abstract]. J Clin Oncol 2020;38(Suppl):Abstract 10002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Long GV, Hodi S, Lipson EJ, et al. Relatlimab and nivolumab versus nivolumab in previously untreated metastatic or unresectable melanoma: overall survival and response rates from RELATIVITY-047 (CA224-047) [abstract]. J Clin Oncol 2022;40(Suppl):Abstract 360385.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Atkins MB, Lee SJ, Chmielowski B, et al. DREAMseq: a phase III trial—ECOG-ACRIN EA6134 [abstract]. J Clin Oncol 2021;39(Suppl):Abstract 356154.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Berk-Krauss J, Stein JA, Weber J, et al. New systematic therapies and trends in cutaneous melanoma deaths among US whites, 1986–2016. Am J Public Health 2020;110:731733.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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