NCCN Guidelines for Patients® | Melanoma

74 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Metastatic melanoma This may include a CT scan of your chest, abdomen, and pelvis; MRI of your brain; and/or a PET/CT scan. Your doctor may also consider doing an x-ray of your chest to watch for cancer spread in your lungs. These tests may be done for up to 3 to 5 years after treatment has ended. Routine imaging tests are not recommended after 3 to 5 years if there has been no recurrence and you don’t have any symptoms. Routine blood tests to check for recurrence are not recommended. Guide 23 shows the first-line and second-line systemic therapy options that are recommended for metastatic or unresectable melanoma. Metastatic melanoma is when the cancer has spread to other organs and parts of the body far away from the primary tumor. Unresectable means all of the cancer can’t be removed by surgery (resection). First-line treatment options First-line treatment is the first treatment or set of treatments given for a disease. There are several first-line treatment options to choose from. One option is to receive treatment with one immunotherapy drug—called a single agent—such as pembrolizumab or nivolumab, which are anti-PD1 inhibitors. Or, you may receive both nivolumab and ipilimumab together—called a combination regimen. If you have melanoma with a mutated BRAF gene, then another option is to receive targeted therapy. Guide 23. Systemic therapy for metastatic or unresectable melanoma First-line therapy Second-line therapy • Immunotherapy: ◦◦ Pembrolizumab ◦◦ Nivolumab ◦◦ Nivolumab/ipilimumab • Immunotherapy: ◦◦ Pembrolizumab ◦◦ Nivolumab ◦◦ Nivolumab/ipilimumab • Targeted therapy if BRAF mutated: ◦◦ Dabrafenib/trametinib ◦◦ Vemurafenib/cobimetinib • Targeted therapy if BRAF mutated: ◦◦ Dabrafenib/trametinib ◦◦ Vemurafenib/cobimetinib • Ipilimumab • High-dose IL-2 • Cytoxic agents: ◦◦ Dacarbazine ◦◦ Temozolomide ◦◦ Paclitaxel ◦◦ Albumin-bound paclitaxel ◦◦ Carboplatin/paclitaxel • Imatinib for tumors with activating mutations of KIT • Consider best supportive care for poor perfomance status