Challenges in melanoma

At EADO 2025, Prof Dr Andrea Forschner from the University Hospital of Tübingen, Germany, explored advances in the treatment of metastatic uveal melanoma, an area historically associated with limited therapeutic success.  

New data and case discussions highlighted promising outcomes achieved through a multidisciplinary approach that includes combinations of systemic immunotherapy, such as nivolumab, ipilimumab, or pembrolizumab, paired with liver-directed therapies like chemosaturation. In select patients, significant tumour reduction was achieved, allowing for the introduction of systemic therapy. Some cases further benefited from the addition of radiotherapy, contributing to unexpectedly long-term survival outcomes. These results mark a notable development in the treatment landscape of uveal melanoma, a disease in which the majority of metastases are liver-confined, with minimal extrahepatic spread. Delivering high-dose chemotherapy via isolated hepatic perfusion spares systemic toxicity and appears to provide a valuable therapeutic window for subsequent immune-based strategies.

In parallel, the evolving role of neoadjuvant immunotherapy in cutaneous melanoma was reinforced by new data. In patients with resectable stage III or IV disease and macroscopic metastases, short-course immunotherapy—typically two cycles of ipilimumab plus nivolumab, or three cycles of pembrolizumab—prior to surgery continues to yield high pathologic response rates. These early interventions are associated with improved outcomes and further support a biology-first treatment model.

The congress also addressed challenges at the opposite end of the treatment spectrum: end-of-life care. A dedicated session moderated by experts emphasised the need for open, compassionate conversations with patients who have exhausted effective options, particularly those without targetable mutations such as BRAF. In these settings, where immune checkpoint inhibitors may no longer offer benefit, the focus shifts toward quality of life and patient-centered decision making. This dialogue underscored the importance of honest communication and supportive care during the final stages of illness.

Collectively, the sessions reflect a maturing field that is both expanding the boundaries of curative treatment and deepening its commitment to patient-centered care across the entire disease continuum.