Melanoma 3.0T-Tech Innovations, New Targeted Therapies, and T-Cell Breakthroughs.

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Abstract

New technologies and innovations are changing the future of melanoma care. Teledermatology and skin screening mobile apps aided by artificial intelligence (AI) diagnostic support could assist in closing disparity gaps in melanoma early detection and access to specialty care. Although the field of AI in dermatology has exploded over the past decade, prospective validation of available algorithms using real-world, multimodal data sets has shown performance decline, limiting their current use in clinical practice. Newer methodological approaches have focused on how AI can augment clinical decision making to speed diagnosis and care delivery-and whether the model output results in a favorable change for the patient. Selective BRAF and MEK inhibitors have an established role in the adjuvant and metastatic setting for the approximately 50% of patients whose melanomas harbor a BRAF V600 mutation. Acquired resistance to these agents remains a challenge, however. For other driver mutations, including class II and III BRAF mutations, alterations in NRAS and CDKN2A, novel agents and combinations are demonstrating promising activity. At least 50% of patients with metastatic melanoma do not derive long-term benefit from immune checkpoint inhibitors (ICIs). Adoptive cellular immunotherapy with tumor infiltrating lymphocytes offers the possibility of a durable response for a minority of these patients. Potentially more effective and better tolerated T-cell therapies are being evaluated in clinical trials.

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