Immunotherapy for the Treatment of Melanoma

Publication Date: October 18, 2023
Last Updated: October 19, 2023

Diagnostic tests and biomarkers

  • For all patients with stage III and stage IV melanoma, BRAF mutation status should be obtained (LE:2).
  • Patients with stage IIB/C melanoma have a high risk of recurrence, therefore BRAF mutation testing can be considered on a case-by-case basis so that treatment options are known at the time of recurrence.
  • For all patients with unresectable/metastatic melanoma, NGS is recommended if feasible.
  • Although PD-L1 tumor proportion score (TPS) and TMB are associated with ICI response in melanoma, they should not be used for clinical decision-making at the time of manuscript publication.
  • MSI and MMR status should not be routinely obtained as a standalone test for patients with melanoma.
  • ctDNA is an exciting new tool to track antitumor response to ICIs and is being explored in research settings, however, this biomarker is not routinely used to guide clinical decision-making for patients with melanoma at the time of manuscript publication.
  • There are many biomarkers under investigation in melanoma (eg, interferon [IFN]γ gene expression signatures, granzyme B PET imaging, gut microbiome profiling) to predict response to ICIs, but none of those are clinically validated and were not routinely used to guide clinical decision-making at the time of manuscript publication.
  • Studies to identify biomarkers to predict risk of developing irAEs and to inform treatment of irAEs are ongoing, but none of these biomarkers were routinely used to guide clinical decision-making at the time of manuscript publication.
()
678

Stage II cutaneous melanoma

  • For patients with T1b and higher, clinically LN-negative melanoma, SLN mapping and biopsy should be discussed and offered, when feasible (LE:2).
  • For patients with resected stage IIB and IIC melanoma, a referral to medical oncology and surveillance with cross-sectional imaging are recommended (LE:3).
  • For patients with resected stage IIB and IIC melanoma, adjuvant pembrolizumab (LE:2) or nivolumab (LE:2), surveillance alone, or clinical trial enrollment are all options. A discussion about the potential risks and benefits associated with adjuvant PD-1 inhibition is recommended as part of a shared decision-making process.
  • For patients with resected stage I and stage IIA melanoma, close surveillance with total skin examination and physical examination of peripheral LN basins should be continued. These patients may also be considered for clinical trials. Routine imaging for these patients in the absence of symptoms is not recommended.
()
678

Overview

Title

Immunotherapy for the Treatment of Melanoma

Authoring Organization