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Melanoma — SCE Medical Oncology MCQ

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HardMelanoma & SkinMelanomaSCE Medical Oncology

A fit adult has untreated unresectable metastatic uveal melanoma, is HLA-A*02:01 positive and has no contraindication to therapy. Which systemic treatment has a NICE recommendation based on demonstrated overall-survival benefit?

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Correct answer: B — First-line tebentafusp for HLA-A*02:01-positive metastatic disease

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · E = shown as D · C = shown as E

A is correct. Tebentafusp is a bispecific T-cell receptor therapy restricted to HLA-A*02:01 and is NICE recommended for untreated unresectable or metastatic uveal melanoma within its marketing authorisation. Its pivotal randomised study demonstrated overall-survival benefit over investigator choice. BRAF-MEK therapy requires an appropriate BRAF alteration and typical uveal melanoma is driven by other biology; pembrolizumab, dacarbazine and nivolumab-ipilimumab have not shown the same randomised survival advantage in this disease, and none is HLA-A*02:01 restricted. HLA testing is therefore treatment defining rather than merely prognostic.

Reference: NICE TA1027 tebentafusp recommendations: https://www.nice.org.uk/guidance/ta1027/chapter/1-Recommendations