Systemic Therapy for Melanoma: ASCO Guideline

Author:

Seth Rahul1,Messersmith Hans2,Kaur Varinder3,Kirkwood John M.45,Kudchadkar Ragini6,McQuade Jennifer Leigh7,Provenzano Anthony8,Swami Umang9,Weber Jeffrey10,Alluri Krishna C.11,Agarwala Sanjiv12,Ascierto Paolo A.13,Atkins Michael B.14,Davis Nancy15,Ernstoff Marc S.16,Faries Mark B.1718,Gold Jason S.19,Guild Samantha20,Gyorki David E.21,Khushalani Nikhil I.22,Meyers Michael O.23,Robert Caroline2425,Santinami Mario26,Sehdev Amikar27,Sondak Vernon K.22,Spurrier Gilliosa28,Tsai Katy K.29,van Akkooi Alexander30,Funchain Pauline31

Affiliation:

1. State University of New York Upstate Medical University, Syracuse, NY

2. American Society of Clinical Oncology, Alexandria, VA

3. University of Virginia, Charlottesville, VA

4. University of Pittsburgh School of Medicine, Pittsburgh, PA

5. University of Pittsburgh Medical Center, Hillman Cancer Institute, Pittsburgh, PA

6. Emory University, Atlanta, GA

7. University of Texas MD Anderson Cancer Center, Houston, TX

8. Columbia Presbyterian Clinical Associates, Bronxville, NY

9. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT

10. Laura and Isaac Perlmutter Cancer Center at New York University, Langone Health, New York, NY

11. St Luke’s Mountain States Tumor Institute, Boise, ID

12. Lewis Katz School of Medicine at Temple University, Philadelphia, PA

13. Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy

14. Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC

15. Vanderbilt University Medical Center, Nashville, TN

16. Roswell Park Cancer Institute, Buffalo, NY

17. The Angeles Clinic and Research Institute, Los Angeles, CA

18. Cedars Sinai Medical Center, Los Angeles, CA

19. Veterans Administration Boston Healthcare System, West Roxbury, MA

20. AIM at Melanoma Foundation, Frisco, TX

21. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

22. H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

23. University of North Carolina School of Medicine, Chapel Hill, NC

24. Gustave Roussy Cancer Centre, Villejuif, France

25. Paris-Saclay University, Villejuif, France

26. Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

27. Indiana University School of Medicine, Indianapolis, IN

28. Melanome France, Teilhet, France

29. Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA

30. Netherlands Cancer Institute, Amsterdam, the Netherlands

31. Cleveland Clinic, Cleveland, OH

Abstract

PURPOSE To provide guidance to clinicians regarding the use of systemic therapy for melanoma. METHODS ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma. RECOMMENDATIONS In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-guidelines .

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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