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Shailender Bhatia and John A. Thompson

important considerations in selecting a treatment from the available options; and highlights some of the promising investigational approaches for this disease. Therapeutic Options for Stage IV Melanoma Although locoregional treatment modalities, such

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John A. Thompson

Over the past 5 years, a host of new agents have radically changed the therapeutic landscape in advanced melanoma; gone are the days when the only active agents were interferon and dacarbazine. Nearly 25 years ago, few patients with stage IV melanoma reached 2-year survival; today, these survival curves have risen substantially. At the NCCN 21st Annual Conference, John A. Thompson, MD, discussed updates with longer duration of patient follow-up for immune checkpoint therapies. He also reviewed some of the newer approvals in advanced melanoma, including the combination of ipilimumab and nivolumab, high-dose ipilimumab, the oncolytic virus therapy talimogene laherparepvec, and the molecularly targeted combination of the BRAF and MEK inhibitors vemurafenib and cobimetinib.

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III and stage IV melanoma Institution: Roswell Park Cancer Institute This is a phase II study to determine the efficacy and safety of single-agent axitinib in the treatment of patients with advanced melanoma. Primary Objective: Determine the

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Daniel G. Coit and Anthony J. Olszanski

is present in approximately half of patients with advanced melanoma. Ipilimumab, which modulates the T-cell response, is the first treatment ever discovered to impart a survival advantage in stage IV melanoma. In the first-line setting, for example

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Jessica S.W. Borgers, Richard P. Tobin, Robert J. Torphy, Victoria M. Vorwald, Robert J. Van Gulick, Carol M. Amato, Dasha T. Cogswell, Tugs-Saikhan Chimed, Kasey L. Couts, Adrie Van Bokhoven, Christopher D. Raeburn, Karl D. Lewis, Joshua Wisell, Martin D. McCarter, Rao R. Mushtaq, and William A. Robinson

adrenal glands highly permissive to melanoma metastases and limiting the efficacy of ICIs. Patients and Methods Patient Selection and Information This single-center, retrospective study included patients with stage IV melanoma aged ≥18 years who

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Leslie A. Fecher and Keith T. Flaherty

2004 ; 139 : 961 – 967 . 9 Neuman H Patel A Hanlon C . Stage-IV melanoma and pulmonary metastases: factors predictive of survival . Ann Surg Oncol 2007 ; 14 : 2847 – 2853 . 10 Kirkwood J Strawderman M Ernstoff M . Interferon

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Daniel G. Coit, John A. Thompson, Alain Algazi, Robert Andtbacka, Christopher K. Bichakjian, William E. Carson III, Gregory A. Daniels, Dominick DiMaio, Marc Ernstoff, Ryan C. Fields, Martin D. Fleming, Rene Gonzalez, Valerie Guild, Allan C. Halpern, F. Stephen Hodi Jr, Richard W. Joseph, Julie R. Lange, Mary C. Martini, Miguel A. Materin, Anthony J. Olszanski, Merrick I. Ross, April K. Salama, Joseph Skitzki, Jeff Sosman, Susan M. Swetter, Kenneth K. Tanabe, Javier F. Torres-Roca, Vijay Trisal, Marshall M. Urist, Nicole McMillian, and Anita Engh

patients with stage IV melanoma, either at presentation or recurrence, may make long-term remission possible for a larger proportion of patients. With the advent of targeted therapy, there is increasing appreciation of the potential therapeutic

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Daniel G. Coit, Robert Andtbacka, Christopher K. Bichakjian, Raza A. Dilawari, Dominick DiMaio, Valerie Guild, Allan C. Halpern, F. Stephen Hodi, Mohammed Kashani-Sabet, Julie R. Lange, Anne Lind, Lainie Martin, Mary C. Martini, Scott K. Pruitt, Merrick I. Ross, Stephen F. Sener, Susan M. Swetter, Kenneth K. Tanabe, John A. Thompson, Vijay Trisal, Marshall M. Urist, Jeffrey Weber, and Michael K. Wong

. 18 Neuman HB Patel A Ishill N . A single-institution validation of the AJCC staging system for stage IV melanoma . Ann Surg Oncol 2008 ; 15 : 2034 – 2041 . 19 Cascinelli N Belli F Santinami M . Sentinel lymph node biopsy in

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Daniel G. Coit, John A. Thompson, Mark R. Albertini, Christopher Barker, William E. Carson III, Carlo Contreras, Gregory A. Daniels, Dominick DiMaio, Ryan C. Fields, Martin D. Fleming, Morganna Freeman, Anjela Galan, Brian Gastman, Valerie Guild, Douglas Johnson, Richard W. Joseph, Julie R. Lange, Sameer Nath, Anthony J. Olszanski, Patrick Ott, Aparna Priyanath Gupta, Merrick I. Ross, April K. Salama, Joseph Skitzki, Jeffrey Sosman, Susan M. Swetter, Kenneth K. Tanabe, Evan Wuthrick, Nicole R. McMillian, and Anita M. Engh

BRAF-targeted therapies are effective for unresectable stage III and stage IV melanoma, 28 – 43 and these drugs are now FDA approved and widely used in this setting. The FDA approved indications are summarized in Table 2 . Based on their efficacy for

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Daniel G. Coit, Robert Andtbacka, Christopher J. Anker, Christopher K. Bichakjian, William E. Carson III, Adil Daud, Raza A. Dilawari, Dominick DiMaio, Valerie Guild, Allan C. Halpern, F. Stephen Hodi Jr., Mark C. Kelley, Nikhil I. Khushalani, Ragini R. Kudchadkar, Julie R. Lange, Anne Lind, Mary C. Martini, Anthony J. Olszanski, Scott K. Pruitt, Merrick I. Ross, Susan M. Swetter, Kenneth K. Tanabe, John A. Thompson, Vijay Trisal, and Marshall M. Urist

significantly altered the initial management of patients with stage IV melanoma, each agent has unique limitations. Ipilimumab is associated with the potential for serious autoimmune toxicity, clinical responses may take months to become apparent, and the