Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of melanoma, version 3.0
J. immunotherap. cancer; 11 (10), 2023
Publication year: 2023
Since the first approval for immune checkpoint inhibitors
(ICIs) for the treatment of cutaneous melanoma more than
a decade ago, immunotherapy has completely transformed
the treatment landscape of this chemotherapy-resistant
disease. Combination regimens including ICIs directed
against programmed cell death protein 1 (PD-1) with
anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) agents
or, more recently, anti-lymphocyte-activation gene 3
(LAG-3) agents, have gained regulatory approvals for
the treatment of metastatic cutaneous melanoma, with
long-term follow-up data suggesting the possibility of
cure for some patients with advanced disease. In the
resectable setting, adjuvant ICIs prolong recurrence-free
survival, and neoadjuvant strategies are an active area of
investigation. Other immunotherapy strategies, such as
oncolytic virotherapy for injectable cutaneous melanoma
and bispecific T-cell engager therapy for HLA-A*02:01
genotype-positive uveal melanoma, are also available
to patients. Despite the remarkable efficacy of these
regimens for many patients with cutaneous melanoma,
traditional immunotherapy biomarkers (ie, programmed
death-ligand 1 expression, tumor mutational burden,
T-cell infiltrate and/or microsatellite stability) have
failed to reliably predict response. Furthermore, ICIs
are associated with unique toxicity profiles, particularly
for the highly active combination of anti-PD-1 plus
anti-CTLA-4 agents. The Society for Immunotherapy of
Cancer (SITC) convened a panel of experts to develop
this clinical practice guideline on immunotherapy for the
treatment of melanoma, including rare subtypes of the
disease (eg, uveal, mucosal), with the goal of improving
patient care by providing guidance to the oncology
community. Drawing from published data and clinical
experience, the Expert Panel developed evidence- and
consensus-based recommendations for healthcare
professionals using immunotherapy to treat melanoma,
with topics including therapy selection in the advanced
and perioperative settings, intratumoral immunotherapy,
when to use immunotherapy for patients with BRAFV600-
mutated disease, management of patients with brain
metastases, evaluation of treatment response, special
patient populations, patient education, quality of life, and
survivorship, among others.