Treating Patients with High-Risk Melanoma

Source: OncLive, May 2023


Sunandana Chandra, MD, MS: Talk briefly about patients with high-risk melanoma. For example, for patients with stage III melanoma, a number of trials have led to approvals initially of high-dose ipilimumab and anti–PD-1, as well as combination BRAF/MEK for those who have a BRAF mutation. For a patient with stage III disease, Dr Khushalani, when do you decide to treat and with what agent, especially if they’re BRAF mutated?

Nikhil Khushalani, MD: Great question. All patients with stage III and resected stage IV disease in our multidisciplinary practice are referred to medical oncology. This includes stage IIIA disease as well as stage IIIB. Of course, we rarely see any stage IIIBs anymore. All of them deserve a discussion with medical oncology about the pros and cons of adjuvant therapy. As you pointed out, there are 3 approved regimens in use.

Ipilimumab is appropriate if this were 5 years ago. High-dose interferon was also appropriate 5 years ago. But I wouldn’t consider any of those to be standards of care as frontline adjuvant regimens right now. I don’t think they should be used at all. It needs to be single-agent pembrolizumab, single-agent nivolumab, or a combination dabrafenib-trametinib for the patient who is BRAF mutated.