Understanding and Treating Mucosal Melanoma

In season 4, episode 4 of Targeted Talks, Richard D. Carvajal, MD, deputy physician in chief and director of Medical Oncology, Northwell Health Cancer Institute, discusses mucosal melanoma and treatment options for the disease.

The prognosis of mucosal melanoma is difficult to treat, and outcomes for patients are not as satisfactory as with other melanoma types, like cutaneous melanoma, according to Carvajal. One factor contributing to poor prognosis in patients with mucosal melanoma is the fact that the disease is often diagnosed in the later stages, Carvajal explains.

Carvajal also notes that there has been an increasing interested in studying the biology of mucosal melanoma, which may lead to better therapies in the future. However, despite clinical trials that investigated chemotherapy vs interferon therapy and the use of checkpoint blockade, there have been no recent FDA approvals for mucosal melanoma.

As clinical trials continue in the mucosal melanoma space, an important question to address will be that neoadjuvant vs adjuvant therapy. Carvajal notes that in the phase 2 SWOG 1801 clinical trial (NCT03698019), neoadjuvant pembrolizumab (Keytruda) showed event-free survival benefit when compared with adjuvant pembrolizumab in patients with stage III-IV disease. Studies looking further into the potential benefit of treatment in the adjuvant setting are ongoing. Moreover, there are novel targeted therapies under investigation for the treatment of mucosal melanoma.

Carvajal explains that while oncologists wait for result from clinical trials that may provide better information regarding treatment, mucosal melanoma treatment should be approached in a multidisciplinary fashion. Oncologists should also strongly consider enrolling their patients onto clinical trials. Outside of the clinical trial setting, Carvajal notes that checkpoint blockade gas been proven effective for the treatment of mucosal melanoma. Still, whether to use an immune checkpoint inhibitor combination like nivolumab (Opdivo) plus ipilimumab (Yervoy) remains an unsewered question in the field.