Melanoma — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinMelanomaSCE Medical Oncology

A 58-year-old man with metastatic melanoma develops new subcutaneous nodules and enlarged lymph nodes 4 months after stopping pembrolizumab (completed 2 years of therapy). Biopsy confirms recurrent melanoma. BRAF V600E mutant. What is the most appropriate treatment?

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Correct answer: C — Rechallenge with pembrolizumab

For melanoma relapsing after prior anti-PD-1 therapy (especially after a treatment-free interval), rechallenge with the same anti-PD-1 antibody is the preferred approach. Data from the KEYNOTE-006 and other series show approximately 50-75% of patients who relapse after a treatment-free period respond to anti-PD-1 rechallenge. Targeted therapy with BRAF/MEK inhibitors is an alternative given BRAF V600E positivity, but is generally reserved if immunotherapy rechallenge fails, to preserve long-term durable benefit potential.

Reference: ESMO 2024 Melanoma Guidelines; Betof Warner et al JCO 2020