Frontline Immunotherapy Treatment Options in Advanced or Metastatic Cutaneous Melanoma

The OncLive Peer Exchange features a panel of oncology experts discussing advancements in treating metastatic melanoma. The discussion opens with a moderator introducing a group of nationally recognized specialists in melanoma and skin cancer from institutions across the United States. Their collective goal is to share knowledge and strategies to help fellow clinicians better navigate the evolving treatment landscape, particularly focusing on the past decade’s progress in immunotherapy and cell therapies.

The panel explores frontline treatment strategies, highlighting the importance of adhering to National Comprehensive Cancer Network guidelines. Two preferred first-line regimens are emphasized: combination immune checkpoint inhibitors, either nivolumab plus ipilimumab or nivolumab plus relatlimab. Additionally, monotherapies using anti–PD-1 agents like pembrolizumab and nivolumab, as well as BRAF-targeted therapies, are discussed. These options are designated as Category 1 recommendations, signifying strong clinical support. The choice among them often depends on balancing efficacy with toxicity, especially because certain combinations, such as nivolumab with ipilimumab, have higher adverse effect risks.

The conversation underscores the need for individualized treatment plans based on the latest clinical data and patient-specific factors. The panelists reference recent data, including updates from the RELATIVITY study, comparing survival outcomes between different immunotherapy combinations. Although findings show comparable outcomes, the absence of head-to-head trials leaves uncertainty about the superior regimen. Experts emphasize that the ultimate goal is to achieve long-term, treatment-free survival for patients. Despite unanswered questions, the panel encourages flexibility in clinical decisions, guided by evolving evidence and patient needs.