Highlights

It depends a little bit on the details, but we follow most patients with Stage I disease within our multidisciplinary clinic. We usually don’t scan those patients per se, although we do sometimes, depending on whether they have expression profiles that are higher risk, but wouldn’t scan them more than once every six months. When you get into Stage II, it’s split – so Stage IIa sort of follows like Stage I, but Stage IIb and IIc are almost like Stage III now given the recent approval of Keytruda. So, for Stage IIb and IIc we scan those patients if we are going to match them with therapy, with anti-PD-1, Keytruda. Stage III, obviously the standard of care is similar, you can offer anti-PD-1 with Keytruda or Opdivo as well as BRAF inhibition with [Tafinlar] and [Mekinist].

More recently, the field has shifted because of the results of the DREAMseq trial, which compared Yervoy/Opdivo versus Tafinlar and Mekinist, so immunotherapy versus targeted therapy, and there was a massive benefit to the immunotherapy in the front line compared with targeted therapy. People already pretty much knew this, but this was really the final nail in the coffin that the standard of care is to give immunotherapy to front-line patients with melanoma in the unresectable or metastatic setting.