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Melanoma — SCE Medical Oncology MCQ

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HardMelanoma & SkinMelanomaSCE Medical Oncology

A patient with metastatic melanoma has tolerated pembrolizumab for 18 months and remains in confirmed complete response. If following the fixed-duration schedule considered in the NICE appraisal, what is the planned maximum course?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Complete 24 months or 35 three-weekly cycles in total and then stop

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

D is correct. The KEYNOTE schedule considered by NICE capped pembrolizumab at two years, equivalent to 35 three-weekly cycles, with earlier discontinuation for progression or unacceptable toxicity. UK practice may individualise cessation and current dosing schedules differ, so this is a planned maximum rather than proof that every complete responder benefits from the final six months. Switching to nivolumab maintenance has no basis, indefinite treatment is not required by the fixed-duration protocol, adding a year ignores elapsed treatment, and surveillance remains necessary after complete response.

Reference: NICE TA366 pembrolizumab for advanced melanoma: https://www.nice.org.uk/guidance/ta366/chapter/4-consideration-of-the-evidence