What are the treatment options for melanoma?

From the Guidelines

The most effective treatment for melanoma is immunotherapy with anti-PD-1 antibodies, such as nivolumab or pembrolizumab, or combination immunotherapy with nivolumab plus ipilimumab, as these treatments have dramatically improved survival rates by enhancing the immune system's ability to recognize and attack cancer cells. For patients with BRAF wild-type, unresectable and/or metastatic cutaneous melanoma, the following treatment options should be offered: nivolumab plus ipilimumab followed by nivolumab, nivolumab plus relatlimab, nivolumab, or pembrolizumab 1. The treatment of melanoma depends on the stage of the disease, with surgical excision with appropriate margins being the primary treatment for early-stage melanoma (Stage 0-II) and immunotherapy or targeted therapy being the primary treatment for Stage IV metastatic melanoma. Some key points to consider when treating melanoma include:

• For Stage III melanoma with regional lymph node involvement, treatment includes complete lymph node dissection followed by adjuvant therapy with immune checkpoint inhibitors like pembrolizumab or nivolumab, or targeted therapy with dabrafenib plus trametinib for BRAF-mutated melanoma 1.
• For patients with BRAF mutant (V600) unresectable and/or metastatic cutaneous melanoma, treatment options include nivolumab plus ipilimumab, nivolumab plus relatlimab, nivolumab, pembrolizumab, dabrafenib plus trametinib, encorafenib plus binimetinib, or vemurafenib plus cobimetinib 1.
• Regular skin examinations, sun protection, and monitoring for treatment side effects are essential components of comprehensive melanoma care 1. It is also important to note that the treatment landscape for melanoma is constantly evolving, with new treatments and combination therapies being developed and approved, such as the use of talimogene laherparepvec (T-VEC) for intralesional therapy 1. In terms of specific treatment regimens, nivolumab plus ipilimumab is typically administered at a dose of 3 mg/kg plus 1 mg/kg IV every 3 weeks for 4 doses, followed by nivolumab monotherapy, while pembrolizumab is typically administered at a dose of 200 mg IV every 3 weeks 1. Overall, the treatment of melanoma requires a comprehensive approach that takes into account the stage of the disease, the presence of BRAF mutations, and the patient's overall health and preferences.

From the FDA Drug Label

KEYTRUDA is a programmed death receptor-1 (PD-1)-blocking antibody indicated: Melanoma for the treatment of patients with unresectable or metastatic melanoma. for the adjuvant treatment of adult and pediatric (12 years and older) patients with Stage IIB, IIC, or III melanoma following complete resection.

• Nivolumab (OPDIVO) and pembrolizumab (KEYTRUDA) are both indicated for the treatment of melanoma.
• Nivolumab (OPDIVO) is indicated for the treatment of patients with unresectable or metastatic melanoma.
• Pembrolizumab (KEYTRUDA) is indicated for the treatment of patients with unresectable or metastatic melanoma, and for the adjuvant treatment of adult and pediatric patients with Stage IIB, IIC, or III melanoma following complete resection.
• The choice of therapy depends on the individual patient's characteristics, such as the stage of the disease, and the presence of other health conditions.
• Both nivolumab (OPDIVO) and pembrolizumab (KEYTRUDA) have been shown to be effective in the treatment of melanoma, with nivolumab (OPDIVO) demonstrating statistically significant improvements in Overall Survival (OS) and Progression-Free Survival (PFS) in the CHECKMATE-067 trial 2.
• Pembrolizumab (KEYTRUDA) has also been shown to be effective in the treatment of melanoma, with a statistically significant improvement in Recurrence-Free Survival (RFS) in the adjuvant setting 3.

From the Research

Therapy Options for Melanoma

• There are various therapy options available for melanoma, including surgical excision, palliative surgery, radiotherapy, chemotherapy, and immunotherapy 4.
• For advanced melanoma, treatments such as ipilimumab, vemurafenib, dabrafenib, trametinib, nivolumab, and pembrolizumab have been approved and are changing clinical practice 4.
• The choice of therapy depends on the stage and severity of the disease, as well as the patient's overall health and preferences.

Surgical Management

• For primary melanoma, wide excision with 1-2 cm margins is the standard of care, depending on the depth of the tumor 5.
• Sentinel lymph node biopsy is indicated for patients with clinically node-negative, intermediate-thickness primary melanomas, and should also be considered in selected patients with thin and thick primaries 5.

Immunotherapy

• Pembrolizumab and nivolumab are anti-PD-1 antibodies that have been approved for the treatment of advanced melanoma 4, 6, 7, 8.
• Pembrolizumab may be recommended over BRAF/mitogen-activated protein kinase kinase inhibitors as the first-line treatment in patients with advanced BRAF V600-mutant melanoma 6.
• There is no significant difference in overall survival between patients treated with pembrolizumab and those treated with nivolumab 8.

Adjuvant Treatment

• Pembrolizumab and nivolumab have been approved for the adjuvant treatment of melanoma to mitigate the risk of recurrence after surgical resection 7.
• Anti-PD-1 therapy with either pembrolizumab or nivolumab has become a standard of care for patients with resected stage III or IV melanoma 7.