Determinants of adjuvant treatment choice between immunotherapy (immune checkpoint inhibitor) and targeted therapy in resected stage III BRAF V600-mutated cutaneous melanoma: a multicenter observational study: MELADJ3.

Abstract

In resected stage III BRAF V600-mutated melanoma, patients are eligible for adjuvant targeted therapy or immune checkpoint inhibitors (ICIs), but no comparative data guide this choice. Understanding factors shaping patient preferences is essential for shared decision-making. To identify factors associated with patient choice between adjuvant ICI or targeted therapy in resected stage III BRAF V600-mutated cutaneous melanoma. This multicenter, prospective, questionnaire-based, cross-sectional study was conducted from November 2024 to July 2025 across oncology centers in France concerning adults with completely resected AJCC8 stage III BRAF V600-mutant melanoma. Patients received standardized information from their oncologist regarding two adjuvant options - anti-PD1 immunotherapy (nivolumab or pembrolizumab) and targeted therapy (dabrafenib plus trametinib) - before making their treatment choice. The primary outcome was treatment selection (ICI vs. targeted therapy). Secondary outcomes consisted of describing determinants of patient decision-making using a structured questionnaire. Among 45 participants, 25 chose ICI and 20 selected targeted therapy. Questionnaire analysis showed that younger, professionally active patients with dependent children were more likely to prefer targeted therapy, valuing autonomy in treatment administration and reduced hospital visits. In contrast, older or nonworking patients more often favored ICI, citing reassurance from regular medical follow-up and the ability to delegate treatment management. Age and employment status were significantly associated with therapeutic choice. Identifying drivers of treatment preference may support more personalized adjuvant strategies. The finding that targeted therapy is favored by younger patients reinforces the relevance of sentinel lymph node biopsy in BRAF-mutated melanoma, despite expanding indications for immunotherapy in earlier stages.