A 78-Year-Old Man With Metastatic Melanoma and a 67-Year-Old Woman With Stage IV Melanoma

Hussein Tawbi, MD, PhD, presents the case of a 78-year-old man with metastatic melanoma and shares his initial impressions.

Hussein Tawbi, MD, PhD, details the incidence rate of melanoma and that appropriate diagnosis includes an MRI to check for brain metastases and molecular testing for BRAF mutations.

Hussein Tawbi, MD, PhD, highlights the importance of BRAF mutations and LDH levels in diagnosing patients with metastatic melanoma and guiding treatment.

Hussein Tawbi, MD, PhD, explains that for patients with melanoma without a BRAF mutation, first-line therapies primarily include immunotherapy-based (IO) checkpoint inhibitors, with PD-1 inhibitor combination therapies being the current standard of care.

Hussein Tawbi, MD, PhD, explains that LAG-3 is a marker of T-cell exhaustion, and combining LAG-3 inhibitors with PD-1 inhibitors can reverse this exhaustion, enhancing T-cell effectiveness and showing therapeutic benefits in patients with metastatic melanoma.

The RELATIVITY-047 trial evaluated relatlimab and nivolumab versus nivolumab alone in patients with metastatic melanoma, revealing improved progression-free survival, while PDL-1 status wasn't predictive of outcomes.

Hussein Tawbi, MD, PhD, emphasizes that combination immunotherapies offer higher efficacy than single agent PD-1 inhibitors for metastatic melanoma; however, patient characteristics guide the choice of treatment regimen, with toxicities playing a key role.

Over the past decade, the frontline treatment landscape for metastatic melanoma has evolved with studies like CheckMate-067 and KEYNOTE-006 highlighting the superiority of PD-1-based therapies over ipilimumab, and recent trials introducing new combination treatments.

Hussein Tawbi, MD, PhD, emphasizes the importance of patient education in managing adverse events from the treatment of metastatic melanoma with checkpoint inhibition, discussing symptom recognition, potential side effects, and treatment adjustments while ensuring team accessibility and patient communication.

Hussein Tawbi, MD, PhD, presents the case of a 67-year-old woman with stage IV melanoma and shared his initial impressions.

Hussein Tawbi, MD, PhD, explains that for BRAF-mutated metastatic melanoma, treatment options include checkpoint inhibitors, single-agent and combination IO therapies, and BRAF and MEK inhibitor combinations, offering varying response rates and progression-free survival periods.

The phase 3 DREAMseq trial compared initial treatments of combination immunotherapy or BRAF/MEK inhibitors for B-Raf mutated melanoma, showing a 20% overall survival benefit at 2 years for immunotherapy as the first-line treatment.

Hussein Tawbi, MD, PhD, explains that if a patient with metastatic melanoma and a BRAF mutation progresses after initial checkpoint inhibitors, either combination immunotherapy or MEK inhibitor therapy is considered, based on disease progression pace and pattern.

Hussein Tawbi, MD, PhD, closes his discussion by sharing some clinical pearls for fellow oncologists treating patients with metastatic melanoma.