The American Society of Clinical Oncology (ASCO) published a special article that provides guidance to clinicians regarding the use of systemic therapy for cutaneous and non-cutaneous melanoma.
The article was published in Journal of Clinical Oncology (online March 31, 2020; doi:10.1200/JCO.20.00198).
ASCO convened an expert panel to conduct a systematic review of published literature for melanoma. The panel identified one systematic review, one meta-analyses, and 34 additional randomized clinical trials.
For adjuvant melanoma, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous disease, the article states. Either of these two agents or the combination of dabrafenib plus trametinib should be offered in BRAF-mutant disease.
As for the use of neoadjuvant therapy in cutaneous disease, the expert panel could not offer a recommendation due to the scarcity of available data.
In the unresectable or metastatic setting, the article suggests three treatment options for patients with BRAF wild-type cutaneous melanoma: ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone. Any of these three options or a combination of BRAF/MEK inhibitor therapy plus dabrafenib and trametinib, encorafenib and binimetinib, or vemurafenib and cobimetinib should be offered in BRAF-mutant disease.
Patients with mucosal melanoma may be offered the same therapies listed for cutaneous melanoma, the article adds. However, no recommendation could be made for or against specific therapy for uveal melanoma due to the scarcity of available data.—Zachary Bessette