Management of Patients With Advanced Melanoma

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Genevieve Boland
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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
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  • 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.

  • 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.

    • PubMed
    • 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
    • PubMed
    • 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
    • PubMed
    • 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.

  • 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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