Site Editor
Soo Park, MD
Soo Park, MD
Posted: Thursday, April 18, 2024
“If you compare [the era before 2011] with right now, we have a lot of different systemic therapy options [for cutaneous melanoma],” stated Douglas B. Johnson, MD, MSCI, of Vanderbilt University Medical Center, at the 2024 NCCN Annual Conference.
A member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Melanoma, Dr. Johnson provided a glimpse at the current treatment landscape for this type of skin cancer, with the clinical trial data in support of the recommendations in the updated NCCN Guidelines. They include combination checkpoint inhibitors, anti–PD-1 and anti–CTLA-4 monotherapies, and mutation-directed therapies across the neoadjuvant, first-line, and later-line settings.
Dr. Johnson first explored the clinical decision-making considerations in the management of stage III resectable nodal melanoma. There is a lack of clarity regarding the optimal NCCN-recommended regimen in the neoadjuvant setting for these patients, he acknowledged. Under study in clinical trials are the use of pembrolizumab as well as the combinations of nivolumab plus ipilimumab and relatlimab-rmbw.
In terms of first-line systemic therapy for metastatic melanoma, “ipilimumab plus nivolumab is probably the default choice over single-agent PD-1 [inhibition],” Dr. Johnson stated. However, he added, this treatment is associated with higher rates of grade ≥ 3 toxicities. “We have a much better safety profile with nivolumab plus relatlimab, with only about a 20% rate of grade 3 to 4 toxicity.”
Finally, Dr. Johnson briefly discussed the findings from the “practice-changing” DREAMseq study, which support the use of immunotherapy with ipilimumab plus nivolumab in most patients before or after targeted therapy with dabrafenib plus trametinib for BRAF-mutated melanoma. And, for later-line options for metastatic disease, the combination of ipilimumab plus nivolumab (from the SWOG S1616 trial) is an active option after disease progression on single-agent anti–PD-1 therapy, he said. Finally, a recently approved, NCCN-recommended option in the later-line setting is treatment with lifileucel, a tumor infiltrating lymphocyte product.
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