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Experts discuss a preference for ipilimumab/nivolumab as the frontline immunotherapy for patients with BRAF-mutant metastatic melanoma given its proven long-term efficacy but acknowledge nivolumab/relatlimab as an option with less toxicity, especially adrenal insufficiency.
The panelists emphasize the importance of obtaining tissue for BRAF-mutation testing and dedicated tissue tracking in patients with metastatic melanoma, with immunohistochemistry followed by confirmatory next-generation sequencing, and discuss the promise of liquid biopsies like ctDNA as a future biomarker tracking modality.
For patients with BRAF-mutant metastatic melanoma, doctors assess symptoms and disease status to determine if they should start treatment with combination immunotherapy, or 8-12 weeks of BRAF/MEK targeted therapy before switching to immunotherapy, which offers the possibility of durable responses or cure.
Expert panelists stress the importance of biomarker testing for BRAF mutations to guide treatment options when a patient is diagnosed with metastatic melanoma.
When a patient with metastatic melanoma patient tests negative for the BRAF V600E mutation, doctors recommend sending the sample for next-generation sequencing testing which can take 2-3 weeks, during which time they may start immunotherapy if the patient has aggressive disease, but ideally should wait for results to guide treatment.