Highlights in melanoma from ASCO 2024

Dr Meredith McKean - Sarah Cannon Research Institute, Nashville, USA

ASCO 2024 was a really exciting conference for melanoma. There were a number of studies that were potentially practice changing and very thought provoking. Certainly the NADINA study presented by Dr Blank during the overall plenary session at ASCO was certainly the headline. This was a randomised clinical trial evaluating two doses of ipilimumab/nivolumab in the neoadjuvant setting versus adjuvant pembrolizumab for patients with resectable stage 3 or stage 4 melanoma. This demonstrated a significant improvement in event free survival. Additionally, based on patients’ pathologic response they either potentially held any further adjuvant therapy for patients that had ≤10% viable tissue at the time of surgery versus for patients that did not potentially switching their therapy to targeted therapy if they had a BRAF mutation.

Certainly a really thought-provoking study that will likely change practice in the neoadjuvant setting for patients with resectable melanoma in that high risk setting. More to come in these settings for these patients that receive neoadjuvant therapy – can we use that information to then modify their adjuvant therapy.

Some other studies that were presented were certainly exciting. So RELATIVITY-048 was a frontline study looking at a combination of ipilimumab, nivolumab and relatlimab. What was demonstrated was a relatively high response rate, very similar to what we see with ipilimumab/nivolumab but a better toxicity profile. So there has been a lot of interest in potentially that immune therapy triplet up front. So I think we’ll see more to come in that space.

Then another eagerly awaited study was the EVAN study that was evaluating for patients with metastatic BRAF mutated melanoma looking at whether or not we should start with a run-in of targeted therapy followed by ipilimumab/nivolumab versus ipilimumab/nivolumab up front. What it demonstrated is that there was very similar progression free survival; early data but similar overall survival. However, there may be some subsets of patients that may benefit from targeted therapy up front, patients with liver metastases, high LDH, that were exploratory in nature but certainly thought provoking.