Systemic therapy of inoperable melanoma

Cutaneous melanoma remains one of the most aggressive malignancies; however, the introduction of immune checkpoint inhibitors and targeted therapy has dramatically improved patient outcomes. This review summarizes current approaches to systemic treatment of unresectable and metastatic melanoma, with a focus on long-term clinical outcomes. Data on combined targeted therapy in patients with BRAF V600-mutated melanoma, as well as the efficacy of PD-1, CTLA-4, and LAG-3 inhibitors used both as monotherapy and in combination regimens, are discussed. Prognostic factors influencing treatment efficacy, including BRAF mutation status, lactate dehydrogenase (LDH) levels, and tumor burden, are analyzed. Particular attention is paid to optimal treatment sequencing in BRAF-mutated melanoma, toxicity associated with combination immunotherapy, and strategies for toxicity reduction. перспективные направления развития systemic treatment are also reviewed, including bispecific antibodies, tumor-infiltrating lymphocyte (TIL) therapy, resistance-overcoming strategies, and combinations with low-dose radiotherapy. Contemporary systemic therapies enable durable disease control and significantly prolong survival in patients with disseminated cutaneous melanoma