The evolving treatment landscape for melanoma

In this video, Prof Dr Bart Neyns, medical oncologist at the University Hospital Brussels, provides a brief overview of the recent changes in the treatment landscape for melanoma patients and addresses some of the challenges that lie ahead.

Arguably one of the most important changes in the management of melanoma over the last 5 years consists of the introduction of immunotherapy and targeted therapy in the management of patients with resectable melanoma. Nowadays, pembrolizumab and nivolumab are available as adjuvant therapy for patients with stage IIa/b disease, while the combination of dabrafenib and trametinib can be used as adjuvant therapy for patients with BRAF-mutant stage III disease. More recently, the SWOG 1808 and NADINA studies have also demonstrated the clinical potential of immune checkpoint inhibitors as neoadjuvant treatment for patients with macroscopic stage III melanoma. In addition to this, studies are underway to evaluate dual immunotherapy (e.g., nivolumab-relatlimab, cemiplimab-fianlimab) in the (neo)adjuvant setting.

In the advanced setting, 10-year data of KEYNOTE-006 and CheckMate-067 indicate that anti PD-1 monotherapy can effectively cure 25-30% of patients. However, the increasing use of immune checkpoint inhibition inhibitors (ICIs) in the (neo)adjuvant setting will have an important impact on the treatment selection in the advanced setting. In this respect, Prof Neyns underscored that we should think beyond PD-1 and actively explore novel treatment strategies for these patients. Several studies are currently looking into the potential of dual ICI therapy with nivolumab-relatlimab or cemiplimab-fianlimab in this setting. For fit anti-PD-1 exposed patients there may also be a role for a treatment with tumour infiltrating lymphocytes (TIL), such as lifileucel. For the moment, the availability TIL therapy is still very limited, but clinical trials with this treatment modality involving Belgian centers are planned for the near future.