Background: The introduction of immuno- and targeted therapeutic modalities meant a breakthrough step in the therapy of melanoma. As a checkpoint inhibitor, the more effective and less toxic anti-PD1 therapy followed an anti-CTLA4 approach. Methods: From our patient pool, 222 advanced melanoma cases were selected, where anti-PD1 (pembrolizumab, nivolumab) therapy was initiated between March 2015 and December 2020. During our retrospective analysis, the efficacy and safety of the therapy were assessed. Results: The median follow-up was 16 months (interval: 0–64 months), and 150 patients (67.6%) received therapy in the first line, while second and third line therapy was performed among 72 patients (32.4%) for the median of 7.0 months (0–60). In 50 cases, BRAF mutations were detected. Ninety-six patients showed objective response (11.3% CR, 32.0% PR). The median PFS was 10.0 months (0–60), and the median OS was 23.0 months (0–64). Autoimmune side effects were found in 79 patients (35.5%); grade 3 occurred in 6.3% of the cases, while 1 patient died due to fulminant pneumonitis (0.25%). Conclusion: Although the range of immunotherapeutic options is getting wider, in the management of melanoma patients, anti-PD1 monotherapy remains an important, effective, and safe method. However, significant correlation was found between the immune-related side effects and therapeutic efficacy.

Background/Objectives: Metastatic uveal melanoma (mUM) carries a poor prognosis and limited systemic treatment options. While immune checkpoint inhibitors have improved outcomes in cutaneous melanoma, their activity in mUM remains modest. Tebentafusp has recently emerged as the first therapy to improve overall survival in HLA-A*02:01–positive patients, but effective options for others remain scarce. This study compared the real-world effectiveness and safety of ipilimumab plus nivolumab versus anti-programmed cell death protein 1 (PD-1) monotherapy. Methods: We conducted a retrospective single-center analysis of patients with mUM treated at the National Institute of Oncology, Budapest. Patients received either dual checkpoint inhibition (ipilimumab plus nivolumab) or anti-PD-1 monotherapy (nivolumab or pembrolizumab). Evaluated outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and immune-related adverse events (irAEs). Survival was analyzed using Kaplan–Meier methods, log-rank tests, and Cox regression. Results: Fifty-five patients were included (33 ipilimumab–nivolumab, 22 anti-PD-1). ORR was 21% versus 5%, and DCR was 42% versus 32%, respectively. Median PFS was 5.8 vs. 3.7 months (p = 0.053; HR 0.61, 95% CI 0.34–1.09), and median OS was 12.3 vs. 10.6 months (p = 0.214; HR 0.66, 95% CI 0.36–1.22). Grade 3–4 irAEs occurred in 48% of patients receiving ipilimumab–nivolumab compared with 9% on monotherapy. No treatment-related deaths were observed. Conclusions: Anti-PD-1 monotherapy demonstrated limited clinical activity, providing little benefit beyond conventional chemotherapy. Dual checkpoint blockade with ipilimumab and nivolumab achieved higher response and disease control rates, albeit with increased toxicity, suggesting a potential benefit for selected patients. Tebentafusp has emerged as an effective option and a new standard of care for a molecularly defined subgroup of HLA-A*02:01–positive patients. However, for the majority of individuals with metastatic uveal melanoma, effective systemic therapies remain an unmet need.

Bevezetés: Áttétes melanomában az innovatív terápiák által lehetővé tett megnövekedett túlélés mellett a terápiás válasz továbbra is meglehetősen heterogén, nem mindig tartós. Oligoprogresszió esetén számos kiegészítő terápiás modalitás áll rendelkezésünkre, többek között a bőrre is áttétet adó daganatok esetében az elektrokemoterápia. Célkitűzés: Az áttétes melanoma elektrokemoterápiájával szerzett tapasztalataink áttekintése. Módszer és eredmények: 2016 és 2021 között 23 melanomás beteg, 10 férfi és 13 nő részesült elektrokemoterápiás kezelésben Intézetünkben. A medián életkor 74,5 év volt. 13 esetben (57%) alsó végtagon, 5 esetben (22%) a fej-nyaki régióban, 4 esetben (17%) felső végtagon és 1 esetben (4%) a törzs régiójában található cutan és subcutan metastasisokat kezeltünk. Az elektrokemoterápiás kezelést megelőzően 7 beteg (30%) kemoterápiát, 6 beteg (26%) immunterápiát és 2 beteg (9%) célzott terápiát kapott, míg 8 beteg (35%) első vonalbeli kezelésként kapta az elektrokemoterápiát. 23 kezelt betegünknél 12 (52%) komplett remissziót, 6 (26%) részleges remissziót értünk el. 1 betegnél (4%) a kezelt gócok mérete állandó volt, 4 esetben (17%) pedig progresszió jelentkezett. Az összegzett válaszadási arány 78%, a medián lokális progressziómentes túlélés 9 hónap volt. A beavatkozást követően 8 beteg (35%) esetében tudtuk folytatni a már korábban elkezdett, hatékony szisztémás kezelést, és 4 beteg (17%) esetében nem volt szükség további szisztémás terápiára. Mellékhatásokat 8 betegen (35%) észleltünk, 1 volt G3-as súlyosságú. Következtetés: Áttétes melanomás betegeink elektrokemoterápiás kezelése hatékony lokális kontrollt, illetve sok esetben túlélési előnyt eredményez, tolerálható mellékhatások mellett, javítva az életminőséget. Orv Hetil. 2023; 164(35): 1381–1386.

Background/Objectives: Over the past few decades, the incidence of melanoma has been steadily rising. In Hungary, the National Institute of Oncology serves as the national center for the diagnosis and treatment of malignancies, including melanoma. This study aims to analyze our patients’ data, providing a comprehensive characterization of melanoma across the country. Methods: We systematically analyzed the clinico-pathological data of melanoma patients treated in the Department of Oncodermatology between 2001 and 2018. Prognostic parameters were collected from the Hospital Information System of the Institute, including gender, age, tumor location, exulceration of primary lesion, Clark level, and Breslow thickness. In addition, survival analysis was also performed. Results: A total of 6267 melanoma patients were included in the study, with a slight predominance of female cases. The most common tumor location was the trunk. Female patients and younger age groups were more likely to present with lower Breslow thickness, while tumors in the head region were associated with increased thickness. Over the study period, the annual median Breslow thickness showed a significant decline. Female gender, younger age, and lower Breslow thickness was correlated with improved overall survival. Over time, the studied patient population exhibited better outcomes. Conclusions: Despite the rising incidence of melanoma in Hungary, the annual median Breslow thickness in our studied patient group showed a decreasing trend, accompanied by improved mortality outcomes. This highlights the critical role of secondary prevention measures and their effectiveness, as well as the impact of novel therapeutic advancements.