FDA-Approved Melanoma Treatments
FDA-APPROVED MELANOMA TREATMENTS
Generic Brand Strength Form Adult Dose
ALKYLATING AGENT
dacarbazine 200mg/vial pwd for IV infusion after reconstitution and dilution Malignant melanoma: 2–4.5mg/kg/day IV for 10 days, may repeat every 4wks; or 250mg/m2 daily for 5 days, may repeat every 3wks.
CTLA-4 BLOCKING ANTIBODY
ipilimumab Yervoy 5mg/mL soln for IV infusion Infuse over 90mins. Unresectable, metastatic: 3mg/kg every 3wks for max 4 doses; may delay doses if toxicity occurs, but all treatment must be given within 16wks of the first dose. Adjuvant (cutaneous): 10mg/kg every 3wks for 4 doses, followed by 10mg/kg every 12wks for up to 3yrs; may omit doses if toxicity occurs.
INTERFERONS
interferon alfa-2b1 Intron A 10 million IU, 18 million IU, 50 million IU; per vial pwd for inj after reconstitution and dilution Malignant melanoma: Induction (use pwd form only): 20million IU/m2 IV over 20mins, 5 consecutive days per week, for 4wks. Maintenance: 10 million IU/m2 SC 3 times per week for 48wks.
10 million IU, 18 million IU, 25 million IU; per vial soln for SC inj
peginterferon alfa-2b Sylatron 296mcg, 444mcg, 888mcg lyophilized pwd for SC inj after reconstitution Adjuvant: 6mcg/kg/week SC for 8 doses, followed by 3mcg/kg/week for up to 5yrs. Renal impairment (moderate): initially 4.5mcg/kg/week for 8 doses, followed by 2.25mcg/kg/week for up to 5yrs; (severe or ESRD on dialysis): initially 3mcg/kg/week for 8 doses, followed by 1.5mcg/kg/week for up to 5yrs.
INTERLEUKIN-2
aldesleukin1 Proleukin 22 million IU/ vial pwd for IV infusion after reconstitution and dilution 600,000 IU/kg (0.037mg/kg) every 8hrs by IV infusion over 15mins for max 14 doses, followed by 9 days rest, then repeat for another 14 doses (max 28 doses/course), as tolerated. Retreatment: see full labeling.
KINASE INHIBITORS
binimetinib Mektovi2 15mg tabs 45mg twice daily (approx. 12hrs apart) with encorafenib until disease progression or unacceptable toxicity. Moderate or severe hepatic impairment: 30mg twice daily. Discontinue if encorafenib is permanently discontinued.
cobimetinib Cotellic2 20mg tabs 60mg once daily for first 21 days of each 28-day cycle, in combination with vemurafenib, until disease progression or unacceptable toxicity.
dabrafenib Tafinlar2 50mg, 75mg caps Take at least 1hr before or 2hrs after a meal. Monotherapy or in combination with trametinib: 150mg twice daily (approx. 12hrs apart) until disease progression or unacceptable toxicity. Adjuvant treatment with trametinib: 150mg twice daily (approx. 12hrs apart) until disease recurrence or unacceptable toxicity for up to 1yr.
encorafenib Braftovi2 75mg caps 450mg once daily with binimetinib until disease progression or unacceptable toxicity.
trametinib Mekinist2 0.5mg, 2mg tabs Take at same time each day, at least 1hr before or 2hrs after a meal. Monotherapy or in combination with dabrafenib: 2mg once daily (approx. 24hrs apart) until disease progression or unacceptable toxicity. Adjuvant treatment with dabrafenib: 2mg once daily (approx. 24hrs apart) until disease recurrence or unacceptable toxicity for up to 1yr.
vemurafenib Zelboraf3 240mg tabs 960mg every 12hrs until disease progression or unacceptable toxicity.
ONCOLYTIC VIRAL THERAPY
talimogene laherparepvec Imlygic 106 (1 million) PFU/mL, 108 (100 million) PFU/mL susp for intralesional inj Inject intralesionally into cutaneous, subcutaneous, and/or nodal lesions. Total inj volume per treatment visit: max 4mL for all injected lesions combined. Initial dose: up to 4mL of 106 (1 million) PFU/mL. 2nd dose: up to 4mL of 108 (100 million) PFU/mL given 3wks later. All subsequent doses (including reinitiation): up to 4mL of 108 (100 million) PFU/mL given 2wks apart. Continue for ≥6mos unless other treatment required or until no lesions to treat; reinitiate if new lesions appear after a complete response.
PD-1/PD-L1 BLOCKING ANTIBODIES
atezolizumab Tecentriq3 60mg/mL soln for IV infusion after dilution Prior to initiation, administer a 28-day treatment cycle of cobimetinib 60mg once daily (21 days on, 7 days off) and vemurafenib 960mg twice daily (Days 1–21) and vemurafenib 720mg twice daily (Days 22–28). Give atezolizumab 840mg IV every 2wks until disease progression or unacceptable toxicity, in combination with cobimetinib 60mg once daily (21 days on, 7 days off) and vemurafenib 720mg twice daily.
nivolumab Opdivo 10mg/mL soln for IV infusion after dilution Infuse over 30mins. Single agent: 240mg every 2wks or 480mg every 4wks until disease progression or unacceptable toxicity. In combination with ipilimumab: 1mg/kg (followed by ipilimumab on the same day) every 3wks for 4 doses, then followed by 240mg every 2wks or 480mg every 4wks (as single agent) until disease progression or unacceptable toxicity. Adjuvant: 240mg every 2wks or 480mg every 4wks until disease recurrence or unacceptable toxicity for up to 1yr.
pembrolizumab Keytruda 25mg/mL soln for IV infusion after dilution Infuse over 30mins. 200mg every 3wks or 400mg every 6wks until disease progression or unacceptable toxicity, or up to 12mos without disease recurrence.
NOTES

1 Recombinant.
2 For melanoma with BRAF V600E or V600K mutations.
3 For melanoma with BRAF V600E mutation only.


Not an inclusive list of medications and/or doses. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

Created 1/2021

This article originally appeared on MPR