Modern treatment and future prospects of cutaneous melanoma

Emri Gabriella (1), Szabó Imre Lőrinc (1), Tímár József (2)
(1) Debreceni Egyetem, Klinikai Központ, Bőrgyógyászati Klinika, Debrecen
(2) Semmelweis Egyetem, Patológiai, Igazságügyi és Biztosítás Orvostani Intézet, Budapest

Cutaneous melanoma is an etiopathogenetically heterogeneous tumour. Molecular diagnostic tests to identify therapeutic targets and predictive markers are becoming increasingly important in melanoma care. Treatment decisions are guided by prognostic criteria (AJCC 8th edition, Melanoma Staging). Based on the relatively high therapeutic efficacy of PD-1 inhibitors and BRAF- + MEK-inhibitor combinations in unresectable metastatic melanoma, clinical trials have been initiated to determine the efficacy of adjuvant use. Considering the relapse-free and distant metastasis-free survival data, adjuvant nivolumab, pembrolizumab and dabrafenib-trametinib therapy have become standard of care in stage III melanoma, and ad juvant nivolumab therapy in stage IV melanoma. The indication for pembrolizumab and nivolumab has since been expanded to include the adjuvant treatment of stage IIB/IIC melanoma. The use of neoadjuvant immunotherapy may be the next major change in melanoma care, given the promising relapse-free and distant metastasis-free survival data from ongoing clinical trials. We do not yet know how (neo)adjuvant therapy affects the outcome of the disease in the event of a later relapse, and what the optimal treatment strategy is in such a situation.


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