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In the largest series of acral melanoma treated with anti-PD-1 antibodies, only about 17 percent responded, and melanomas of the nail apparatus responded least, showing that acral disease benefits less from immunotherapy than ordinary skin melanoma.
Retrospective multicentre study of 193 Japanese patients with advanced acral melanoma treated with nivolumab or pembrolizumab monotherapy.
Objective response was 16.6 percent overall (21.3 percent for palm and sole melanoma, 8.3 percent for nail apparatus melanoma), with median progression-free survival of 3.5 months and overall survival of 18.1 months; a higher tumour burden and nail apparatus origin predicted poor outcome.
Acral melanoma needs its own treatment evidence: anti-PD-1 monotherapy has limited activity, so combination immunotherapy, KIT-directed therapy and trials of CDK4/6 inhibitors are important options.