Treatment of Amelanocytic Melanoma in Unresectable or Metastatic Cutaneous Melanoma — BRAF Wild-Type
This protocol covers the treatment of patients with unresectable and/or metastatic cutaneous melanoma in whom no BRAF mutation is identified (BRAF wild-type), for whom BRAF-targeted agents are not an option.
Clinical Scenario
Patients with confirmed BRAF wild-type, unresectable and/or metastatic cutaneous melanoma require an evidence-based treatment pathway distinct from BRAF-mutant disease. Molecular confirmation of BRAF wild-type status is central to appropriate therapy selection in this population.
Treatment Approach (Partial — Full Protocol Required)
For BRAF wild-type unresectable or metastatic cutaneous melanoma, evidence-based guidelines support immunotherapy-based strategies. In patients who have progressed on prior anti-PD-1-based therapy, ipilimumab-containing regimens are a recognised option — the specific agents, combinations, and sequencing are detailed in the full protocol.
References
DOI: 10.1200/JCO.23.01136
- For patients with BRAF wild-type, unresectable and/or metastatic cutaneous melanoma, the following treatment options should be offered (in no particular order): nivolumab plus ipilimumab followed by nivolumab OR nivolumab plus relatlimab OR nivolumab OR pembrolizumab.
- After progression on anti–PD-1–based therapy, patients with unresectable and/or metastatic BRAF wild-type cutaneous melanoma may be offered ipilimumab or ipilimumab containing regimens.
- It should be noted that ipilimumab at 3 mg/kg once every 3 weeks for up to four doses has been approved by the US FDA in these patients on the basis of the trial by Hodi et al.
- In addition, ipilimumab-containing regimens could potentially include nivolumab plus ipilimumab in patients who have progressed on single-agent nivolumab or pembrolizumab.
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