Adjuvant Treatment for Resected Stage IV Cutaneous Melanoma
Clinical Scenario
This protocol applies to patients with amelanocytic melanoma who have undergone complete resection of stage IV cutaneous disease. Despite surgical clearance, recurrence risk remains significant, and adjuvant systemic therapy is a recognised standard consideration in this setting.
Population
Patients with resected stage IV melanoma should be offered adjuvant therapy. This recommendation is supported by moderate-quality evidence with a strong consensus recommendation.
Treatment Approach — partial overview
Adjuvant immunotherapy is a central component of the recommended treatment. For patients whose tumors carry a specific targetable mutation, a targeted combination therapy may also be an option. The complete regimen selection criteria, sequencing, and all clinical decision points are available in the full structured protocol.
References
DOI: 10.1200/JCO.23.01136
- Patients with resected stage IV melanoma should be offered adjuvant therapy (Type: Informal consensus; Evidence quality: Moderate; Strength of recommendation: Strong).
- Reasonable options for therapy are: nivolumab alone (Evidence quality: Moderate), nivolumab plus ipilimumab followed by nivolumab (Evidence quality: Low), pembrolizumab alone (Evidence quality: Low), and dabrafenib plus trametinib (in patients with BRAF V600E/K disease; Evidence quality: Low).
- Nivolumab 1 mg/kg iv plus ipilimumab 3 mg/kg iv once every 3 weeks for four doses, followed by nivolumab 3mg/kg once every 2 weeks for 1 year or until disease recurrence, whichever comes first (IMMUNED trial).
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