The case for adjuvant BRAF-targeted therapy versus adjuvant anti-PD-1 therapy for patients with resected, high-risk melanoma.

The development of highly effective BRAF-targeted therapy and immune checkpoint inhibition for patients with advanced metastatic melanoma has transformed the treatment of this disease. More recently, these advances have moved into the resected, high-risk stage II and III settings. For patients with resected, BRAF-mutant stage III melanoma, there are no head-to-head data to support the use of BRAF-targeted therapy (specifically the combination of dabrafenib and trametinib) with either single-agent nivolumab or pembrolizumab. Because the relapse-free and distant metastasis-free survivals are similar in a cross-trial comparison, it is not clear what the best option for these patients is. In this piece, the authors argue on behalf of and against both approaches. PLAIN LANGUAGE SUMMARY: Two types of therapy exist for patients diagnosed with melanoma who have completed surgery and remain at high risk for tumor recurrence: (1) drugs that target the BRAF mutation (found in ∼50% of patients) and (2) immunotherapy. There are no data showing that either approach is better than the other, so the choice of which therapy is best for an individual patient can be challenging. In this article, we make arguments for and against each option.