Melanoma

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Melanoma

Treatment Options

Adjuvant therapy

Metastatic - extend overall survival

Combo BRAF/MEK inhibitor

Nivolumab + Ipilimumab

recommended first line for metastatic melanoma regardless of PDL1 expression

Pembrolizumab

Non-metastatic - decrease recurrence time

Topical imiquimod or radiation if exclusion

Dabrafenib/trametinib (BRAF V600)

Ipilimumab

Surgery

Primary treatment

Drugs

PD-1 inhibitors

pembrolizumab

approved as single agent for resectable or metastatic melanoma

Nivolumab

approved for adjuvant treatment after complete resection

approved for single agent and in combo w/ ipilmumab for unresectable or metastatic melanoma

CTLA4 inhibitors

Ipilmumab

Tox rash diarrhea liver tox hypophysitis

manage diarrhea and livertox w/ high dose steroids infliximab second line for diarrhea mycophendlate second line for liver tox

infliximab contraindicated in liver disease

has the highest tox among checkpoint inhibitors

BRAF/MEK inhibitors

tox skin oddities pyrexia diarrhea eleved CK and LFTs

trametinib + cobimetinib

Dabrafenib + vemurafenib

also approved for adjuvant therapy for pt w/ mutation w/ lymph node involvement following complete resection

Approved for unresectable or metastatic melanoma w/ BRAF V600 mutations

IL-2

tox capillary leak syndrome constitutional symptoms infections N/V chills

Steroids are CONTRAINDICATED due to risk of infections and GI side effects

administed in ICU

approved for metastatic melanoma

IFN alpha-2b

Avoid in autoimmune chronically immunosuppressed liver disease severe neuropsychiatric diseases life-treat infection

tox granulocytopenia increased LFTs flu symptoms depression anorexia fatigue

approved for stage III high risk

Staging

Metastatic (Stage IV)

Systemic therapy for stage IV

Regional (Stage III)

Adjuvant therapy for stages IIB-IIIC

Localized (Stage I-II)

Surgery for stages 0-IIA