American Society of Clinical Oncology
Systemic Therapy for Melanoma
This guideline holds 19 recommendations, 130 references, 4 tables and 1 figure.
Summary
Systemic treatment for melanoma has changed rapidly since the introduction of ipilimumab in 2011, substantially improving overall and long-term survival. Due to the increasing availability of new therapies, rising melanoma incidence, and treatment costs, rational evidence-based selection of appropriate therapy is essential.
Key takeaways
Neoadjuvant pembrolizumab is newly recommended for patients with resectable stage IIIB-IV cutaneous melanoma.
Adjuvant nivolumab or pembrolizumab is newly recommended for resected stage IIB-C cutaneous melanoma.
Adjuvant nivolumab plus ipilimumab was added as a potential option for stage IV disease.
Nivolumab plus relatlimab is an option for unresectable or metastatic cutaneous melanoma regardless of BRAF mutation status.
Nivolumab plus ipilimumab followed by nivolumab is preferred over BRAF/MEK inhibitor therapy as first-line treatment.
Tebentafusp is recommended for HLA-A*02:01-positive patients with metastatic uveal melanoma.
What is new in this version
Neoadjuvant pembrolizumab added for resectable stage IIIB-IV. Adjuvant nivolumab or pembrolizumab added for stage IIB-C. Adjuvant nivolumab + ipilimumab added for stage IV. Nivolumab + relatlimab added as an option for unresectable/metastatic regardless of BRAF mutation. Nivolumab + ipilimumab preferred over BRAF/MEK inhibitor therapy in first line. T-VEC removed as option for BRAF wild-type progressing on anti-PD-1. Ipilimumab regimens removed for BRAF-mutated disease after progression on other therapies.
