Metastatic melanoma, immunotherapy and long-term survival: Where do we stand?

Over the past dozen years, the prognosis of metastatic melanoma has changed radically with the advent of immunotherapies using immune checkpoints blockers and targeted therapies, the latter only for melanomas carrying a BRAF mutation. The overall median survival of patients has increased from less than one year to more than five years with immunotherapies, with a real hope for cure for some patients. This therapeutic revolution required a modification of cancer assessment criteria because the kinetics and response profiles are different than the ones observed with chemotherapy or targeted therapies. The spectrum of adverse events is also quite different from conventional cancer treatments with sometimes severe immune-mediated side effects. Today, there are still many unknowns concerning primary or secondary resistance mechanisms and the existence of predictive markers of response or success. To fight against therapeutic resistance, new immunotherapies are being developed, sometimes combined with checkpoint inhibitors. The objective, for the next few years, is indeed to be able to cure mor epatients and to treat them earlier in the course of their disease by offering these treatments in an adjuvant or even a neoadjuvant context. We also need to optimize the efficacy/toxicity ratio of these treatments. In total, for more than 12 years now, progress in the management of melanoma continues to pave the way for the development of immunotherapy in oncology. (c) 2023 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.