Immunotherapy Combinations and Monotherapy Considered in a Patient With Metastatic Melanoma

Source: Targeted Oncology, June 2023

During a Targeted Oncology™ Case-Based Roundtable™ event, Sajeve S. Thomas, MD, discussed key trials of immunotherapy in terms of safety and efficacy for patients with metastatic melanoma.


  • 78-year-old man has a history of stage III melanoma.
  • Patient underwent surgical resection 12 years prior.
  • Lymph node dissection (LND) was positive for nodal involvement.
  • Patient declined complete LND and adjuvant systemic therapy.
  • Patient remained active since his surgery and maintained regular follow-up.
  • On routine follow-up, the patient now presented with moderate asthenia that limited his daily activities, without other relevant clinical symptoms.
  • ECOG performance status:
  • Physical examination was unremarkable.
  • Notable laboratory findings: lactate dehydrogenase (LDH) level of 380 UI/L (reference range, 110-240 UI/L)
  • Full-body CT scan revealed the presence of pulmonary and hepatic nodules but no evidence of brain metastases.
  • The patient underwent core-needle biopsy of the largest hepatic lesion in segment IVb without any complications.
  • Pathology revealed metastatic melanoma.
  • Mutation testing: BRAF negative

TARGETED ONCOLOGY: Can you discuss dual therapy vs monotherapy first-line options for stage IV melanoma?