First-Line Treatment for Unresectable or Metastatic Cutaneous Melanoma: BRAF Wild-Type (No BRAF V600 Mutation)
Clinical Scenario
This protocol applies to patients with unresectable and/or metastatic cutaneous melanoma confirmed to be BRAF wild-type — tumour molecular testing has excluded a BRAF V600 mutation, ruling out BRAF-targeted therapy as an option.
BRAF wild-type — no BRAF V600 mutation
First-line management centres on immunotherapy-based approaches, with both combination regimens and monotherapy options supported by guideline evidence. Which regimen is appropriate depends on the individual patient context — the complete structured protocol details all recommended options.
Full regimen selection, administration details, and supporting trial evidence are available in the complete protocol below.
References
- 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.
- Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg iv once every 3 weeks for 4 doses, followed by nivolumab 3 mg/kg iv once every 2 weeks (CheckMate 067).
- Relatlimab 160 mg and nivolumab 480 mg iv once every 4 weeks until progression (RELATIVITY-047).
- Nivolumab 3 mg/kg iv once every 2 weeks (CheckMate 067).
- Pembrolizumab 200 mg iv once every 3 weeks (US FDA-approved).
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