OpenOnco · Melanoma · Stage III resected · Adjuvant pembro (KEYNOTE-054)
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OpenOnco · Treatment Plan
Treatment plan — Cutaneous melanoma
PLAN-MELANOMA-ADJ-PEMBRO-STAGE3-001-V1 · v1 · 2026-08-18
Patient
MELANOMA-ADJ-PEMBRO-STAGE3-001 · Algorithm: ALGO-MELANOMA-METASTATIC-1L
DiagnosisCutaneous melanoma
MOH / ICD-10C43
ICD-O-38720/3; C44.9
StageIIIB
Histologycutaneous_melanoma

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
✅ Covered biomarkers (matched in KB)
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
No clinically actionable variants matched in this profile.
⚠️ Not included in plan
BiomarkerStatus
BIO-BRAF-V600EExcluded (negative)
BIO-BRAF-V600KExcluded (negative)
BIO-NRASNot in KB — ask clinician to verify
BIO-KITBIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan
★ DEFAULT
Indication
IND-MELANOMA-ADJUVANT-PEMBRO-STAGE-III
Regimen
Pembrolizumab adjuvant (resected stage III/IV melanoma; KEYNOTE-054)
Drugs + NSZU
  • Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w (or 400 mg IV q6w) · Day 1 every 3 weeks (or q6w), for up to 18 cycles (~12 months total) starting within 12 weeks of definitive surgery · IV ✓ NSZU covered
Reason
Primary current-line option selected by ALGO-MELANOMA-METASTATIC-1L at step 0; branch-driving red flag: RF-MELANOMA-STAGE-III-RESECTED.

Other current-line alternatives (3 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
Standard plan
Indication
IND-MELANOMA-METASTATIC-1L-NIVO-IPI
Regimen
Nivolumab + ipilimumab (melanoma, 1L metastatic)
Drugs + NSZU
  • Nivolumab (DRUG-NIVOLUMAB) 1 mg/kg IV induction → 480 mg flat IV q4w maintenance · Induction with ipi cycles 1-4 · IV ✓ NSZU covered
  • Ipilimumab (DRUG-IPILIMUMAB) 3 mg/kg IV (higher than RCC) · Days 1 of cycles 1-4 · IV ✓ NSZU covered
Reason
Current-line alternative presented for HCP consideration
Aggressive plan
Indication
IND-MELANOMA-BRAF-METASTATIC-1L-DABRA-TRAME
Regimen
Dabrafenib + trametinib (BRAF V600E+ NSCLC)
Drugs + NSZU
  • Dabrafenib (DRUG-DABRAFENIB) 150 mg PO BID · Continuous · PO ✓ NSZU covered
  • Trametinib (DRUG-TRAMETINIB) 2 mg PO once daily · Continuous · PO ✓ NSZU covered
Reason
Current-line alternative presented for HCP consideration
Standard plan
Indication
IND-MELANOMA-METASTATIC-1L-PEMBRO-MONO
Regimen
Pembrolizumab monotherapy (advanced/metastatic melanoma, 1L; KEYNOTE-006)
Drugs + NSZU
  • Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w (or 400 mg IV q6w) · Day 1 every 3 weeks (or q6w), for up to 35 cycles (~2 years) or until progression / unacceptable toxicity · IV ✓ NSZU covered
Reason
Current-line alternative presented for HCP consideration

Why this branch was chosen

Triggers from the patient profile that fired and drove the chosen branch.
Step 0 → branch IND-MELANOMA-ADJUVANT-PEMBRO-STAGE-III
  • RF-MELANOMA-STAGE-III-RESECTED ★ winner: Resected stage III cutaneous melanoma — adjuvant-eligible biology (positive sentinel-lymph-node biopsy or clinically detected nodal disease, surgically resected via wide local excision ± completion lymphadenectomy or therapeutic neck/inguinal dissection per surgical judgment). Treatment-defining: shifts the patient out of the metastatic 1L pathway into adjuvant immunotherapy (KEYNOTE-054 pembrolizumab × 12 months, CheckMate-238 nivolumab × 12 months) or adjuvant BRAFi+MEKi (COMBI-AD dabrafenib + trametinib) for BRAF V600 mutants. Adjuvant therapy initiated within 12 weeks of definitive surgery per the registration trials. SRC-NCCN-MELANOMA-2025SRC-ESMO-MELANOMA-2024SRC-KEYNOTE-054-EGGERMONT-2018SRC-CHECKMATE-238-WEBER-2017SRC-COMBI-AD-LONG-2017

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks
IDNamePriorityCategoryWhere to orderNeeded for
TEST-CECT-CAPCECT chest/abdomen/pelvisCriticalimagingall tracks
TEST-LDHLactate DehydrogenaseCriticallabstandard
TEST-BRAIN-MRI-CONTRASTBrain MRI with contrastStandardall tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track
  • LDH >2x ULN OR severe hepatic dysfunction — predictor of inferior ICI outcomes.
    LDH integral AJCC staging variable.
    RF-MELANOMA-ORGAN-DYSFUNCTIONSRC-NCCN-MELANOMA-2025SRC-ESMO-MELANOMA-2024
  • Symptomatic CNS metastases — ICI doublet (nivo+ipi) intracranially active; BRAFi+MEKi for visceral crisis.
    CheckMate-204: nivo+ipi ICR ~46% in active brain mets.
    RF-MELANOMA-TRANSFORMATION-PROGRESSIONSRC-NCCN-MELANOMA-2025SRC-ESMO-MELANOMA-2024

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-MELANOMA-ADJUVANT-PEMBRO-STAGE-III)
  • Do not start adjuvant IO without negative baseline brain MRI with contrast — occult cerebral metastases are a frequent finding.
  • Do not skip baseline TSH / cortisol / glucose — endocrine irAE are the most frequent, and pre-existing endocrinopathies change management.
  • Do not start later than 12 weeks from surgery — KEYNOTE-054 window is shorter; benefit poorly characterized after that.
  • Do not continue with gr ≥3 irAE without reassessing benefit/risk — adjuvant is curative intent, threshold for permanent discontinuation lower than metastatic.
  • Do not combine with immunosuppression or live vaccines.
  • Do not skip pre-treatment counseling — irAE may be permanent (endocrinopathies) and impact quality of life more than relapse in some scenarios.
Standard plan (IND-MELANOMA-METASTATIC-1L-PEMBRO-MONO)
  • Do not start pembrolizumab without baseline TSH / cortisol / glucose — endocrine irAE are the most frequent.
  • Do not ignore active autoimmune disease — relative contraindication, assess risk/benefit with rheumatologist.
  • Do not skip baseline brain MRI with contrast — cerebral metastases are often asymptomatic in melanoma.
  • Do not continue with gr ≥3 irAE without high-dose steroids (1-2 mg/kg prednisolone-equivalent) — delay in management can be fatal.
  • Do not combine with immunosuppressants / live vaccines during treatment.
  • Do not prescribe with ECOG ≥3 — limited data, palliative approach more appropriate.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Pembrolizumab adjuvant (resected stage III/IV melanoma; KEYNOTE-054)
21-day cycles × 18 cycles (~12 months) per KEYNOTE-054 protocol

Standard plan

Induction · Nivolumab + ipilimumab (melanoma, 1L metastatic)
21-day cycles × 4 induction; nivo maintenance until progression OR 2 years

Aggressive plan

Induction · Dabrafenib + trametinib (BRAF V600E+ NSCLC)
28-day cycles × Continuous until progression

Standard plan

Induction · Pembrolizumab monotherapy (advanced/metastatic melanoma, 1L; KEYNOTE-006)
21-day cycles × Up to 35 cycles (~2 years) or until progression

MDT brief

Discussion questions (1, 0 blocking)

MDT talk tree (3 steps)

#OwnerTopicAction
1hematologistStaging / disease burden What is the current LDH? Marker of tumor burden and transformation.
2clinical_pharmacistSpecialist review Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
3molecular_geneticistSpecialist review Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

Skills (recommended) — for consideration (2)

  • Clinical pharmacist recommended
    Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
  • Molecular geneticist / molecular oncologist recommended
    Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.
  • Biomarker coverage: 1/1 known (100%), 0 missing, 0 default-track gaps
  • Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-BAP1-CONFIRMED-CARRIER, RF-CDKN2A-SPECIFIC-PDAC-CARRIER, RF-ENVIRONMENTAL-OUTDOOR-UV-SKIN-PREVENTION, RF-FAMMM-CONFIRMED-CARRIER, RF-LIFESTYLE-UV-EXPOSURE-PREVENTION, RF-MELANOMA-BRAF-V600-ACTIONABLE, RF-MELANOMA-INFECTION-SCREENING, RF-MELANOMA-IO-RESISTANT, RF-MELANOMA-KIT-MUT-ACTIONABLE, RF-MELANOMA-NF1-MUT-CANDIDATE, RF-MELANOMA-ORGAN-DYSFUNCTION, RF-OCC-FIREFIGHTER-PREVENTION, RF-UVEAL-MELANOMA-BAP1-MUT-CANDIDATE, RF-WERNER-CONFIRMED-CARRIER
Technical MDT skill metadata (2/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
Specialistskill_idVersionLast reviewedSign-offsDomain
Cellular therapy specialist (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Clinical pharmacistclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Hematologist / oncohematologisthematologistv0.1.02026-04-250hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)hematopathologistv0.1.02026-04-250hematopathology
Infectious disease / hepatologyinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Medical oncologist (solid-tumor chemotherapist)medical_oncologistv0.1.02026-04-250solid_oncology
Molecular geneticist / molecular oncologistmolecular_geneticistv0.1.02026-04-250molecular_oncology
Palliative carepalliative_carev0.1.02026-04-250palliative_care
Pathologist (general)pathologistv0.1.02026-04-250pathology
Primary care / family physicianprimary_carev0.1.02026-04-250primary_care
Psycho-oncologistpsychologistv0.1.02026-04-250psychosocial
Radiation oncologistradiation_oncologistv0.1.02026-04-250radiation_oncology
Radiologistradiologistv0.1.02026-04-250diagnostic_imaging
Social worker / case managersocial_worker_case_managerv0.1.02026-04-250psychosocial
Surgical oncologistsurgical_oncologistv0.1.02026-04-250surgical_oncology
Transplant specialist (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-08-18.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06861023Review of the Literature and Serie of Patients Who Underwent Reconstruction After Wide Local Excision of Nail Apparatus for MelanomaN/ARECRUITINGCentre Hospitalier Universitaire de NiceSmall N (<50) Single country
NCT07215988Studying Off Label Insurance Coverage for Patients With Cutaneous Cancers a "Filter" Observational StudyN/ARECRUITINGOhio State University Comprehensive Cancer CenterSingle country
NCT06121180Study of Cemiplimab Plus Ziv-Aflibercept for Subjects With Metastatic Uveal MelanomaPHASE2RECRUITINGH. Lee Moffitt Cancer Center and Research InstituteSmall N (<50) Surrogate endpoint only Single country
NCT06060613Safety and Efficacy of OBX-115 in Advanced Solid TumorsPHASE1 / PHASE2RECRUITINGObsidian Therapeutics, Inc.
NCT01205815Storage and Research Use of Human Bio-specimens From Melanoma Patients and Clinical Testing for Assignment of TreatmentN/ARECRUITINGVanderbilt-Ingram Cancer CenterSingle country
NCT07057596Neoadjuvant Tebentafusp in Patients With Metastatic Uveal MelanomaPHASE2RECRUITINGGrupo Español Multidisciplinar de MelanomaSmall N (<50)
NCT05086692A Beta-only IL-2 ImmunoTherapY StudyPHASE1 / PHASE2RECRUITINGMedicenna Therapeutics, Inc.
NCT05269381Personalized Neoantigen Peptide-Based Vaccine in Combination With Pembrolizumab for Treatment of Advanced Solid TumorsPHASE1 / PHASE2RECRUITINGMayo ClinicSurrogate endpoint only Single country
NCT07225036Promoting Immunotherapy Efficacy With Low-Dose Liver RTNARECRUITINGJordan KharofaSmall N (<50) Surrogate endpoint only Single country
NCT06150664A Phase 1 of CTX-8371 in Patients With Advanced MalignanciesPHASE1RECRUITINGCompass TherapeuticsPhase 1 only Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
OptionUA registrationNSZUCost orientationAccess pathway
Standard plan
Pembrolizumab adjuvant (resected stage III/IV melanoma; KEYNOTE-054) (REG-PEMBRO-ADJUVANT-MELANOMA)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Standard plan
Nivolumab + ipilimumab (melanoma, 1L metastatic) (REG-NIVO-IPI-MELANOMA)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Aggressive plan
Dabrafenib + trametinib (BRAF V600E+ NSCLC) (REG-DABRAFENIB-TRAMETINIB-NSCLC)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Standard plan
Pembrolizumab monotherapy (advanced/metastatic melanoma, 1L; KEYNOTE-006) (REG-PEMBRO-MONO-MELANOMA)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT06861023
Review of the Literature and Serie of Patients Who Underwent Reconstruction After Wide Local Excision of Nail Apparatus for Melanoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07215988
Studying Off Label Insurance Coverage for Patients With Cutaneous Cancers a "Filter" Observational Study
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06121180
Study of Cemiplimab Plus Ziv-Aflibercept for Subjects With Metastatic Uveal Melanoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06060613
Safety and Efficacy of OBX-115 in Advanced Solid Tumors
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT01205815
Storage and Research Use of Human Bio-specimens From Melanoma Patients and Clinical Testing for Assignment of Treatment
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07057596
Neoadjuvant Tebentafusp in Patients With Metastatic Uveal Melanoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05086692
A Beta-only IL-2 ImmunoTherapY Study
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05269381
Personalized Neoantigen Peptide-Based Vaccine in Combination With Pembrolizumab for Treatment of Advanced Solid Tumors
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07225036
Promoting Immunotherapy Efficacy With Low-Dose Liver RT
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06150664
A Phase 1 of CTX-8371 in Patients With Advanced Malignancies
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-08-18.