The treatment of advanced melanoma: Current approaches and new challenges
Andrea Boutros, Elena Croce, Marco Ferrari, Riccardo Gili, Giulia Massaro, Riccardo Marconcini, Luca Arecco, Enrica T. Tanda, Francesco Spagnolo
Abstract
In recent years, advances in melanoma treatment have renewed patient hope. This comprehensive review emphasizes the evolving treatment landscape, particularly highlighting first-line strategies and the interplay between immune-checkpoint inhibitors (ICIs) and targeted therapies. Ipilimumab plus nivolumab has achieved the best median overall survival, exceeding 70 months. However, the introduction of new ICIs, like relatlimab, has added complexity to first-line therapy decisions. Our aim is to guide clinicians in making personalized treatment decisions. Various features, including brain metastases, PD-L1 expression, BRAF mutation, performance status, and prior adjuvant therapy, significantly impact the direction of advanced melanoma treatment. We also provide the latest insights into the treatment of rare melanoma subtypes, such as uveal melanoma, where tebentafusp has shown promising improvements in overall survival for metastatic uveal melanoma patients. This review provides invaluable insights for clinicians, enabling informed treatment choices and deepening our understanding of the multifaceted challenges associated with advanced melanoma management. • Ipilimumab/nivolumab is the regimen of choice, achieving a mOS of over 70 months. • New ICIs, like relatlimab, add complexity to first-line therapy decisions. • Brain metastases, PD-L1, BRAF, PS, prior adjuvant, guide advanced melanoma treatment • Tebentafusp improved OS for metastatic uveal melanoma patients