Systemic Therapy for Melanoma: ASCO Guideline.

Area of Science:

• Oncology
• Clinical Therapeutics
• Dermatology

Background:

• Melanoma is a significant public health concern requiring effective systemic therapies.
• Advances in understanding melanoma genetics, particularly BRAF mutations, have led to targeted treatment options.

Purpose of the Study:

• To provide evidence-based guidance to clinicians on the optimal use of systemic therapy for melanoma.
• To synthesize current evidence for treating various stages and subtypes of melanoma.

Main Methods:

• A systematic review and meta-analysis of relevant literature were conducted.
• An Expert Panel convened by ASCO evaluated randomized trials and published studies on systemic melanoma therapies.

Main Results:

• For adjuvant therapy in stage IIIA/B/C/D BRAF wild-type melanoma, nivolumab or pembrolizumab are recommended.
• For BRAF-mutant melanoma, adjuvant options include nivolumab, pembrolizumab, or dabrafenib/trametinib.
• In unresectable/metastatic settings, ipilimumab/nivolumab, nivolumab, or pembrolizumab are recommended for BRAF wild-type disease.
• For BRAF-mutant metastatic melanoma, combination BRAF/MEK inhibitors (dabrafenib/trametinib, encorafenib/binimetinib, vemurafenib/cobimetinib) are recommended alongside immunotherapy options.

Conclusions:

• Specific systemic therapies are recommended for different stages and molecular subtypes of cutaneous melanoma.
• Guidance is provided for mucosal melanoma, while no recommendations could be made for uveal melanoma.
• The guidelines aim to optimize patient outcomes through informed treatment selection.