Immunotherapy for patients with melanoma in East Asia: current evidence, future directions, and clinical implications

INTRODUCTION: Melanomas cause the vast majority of skin-cancer related deaths, despite accounting for only around 2% of skin cancer cases. Moreover, due to genetic and environmental factors, the melanomas that predominate in East Asian populations, generally acral and mucosal melanomas, are extremely rare in Caucasian populations. These melanomas differ from other cutaneous melanomas in clinicopathological features and mutational landscapes, including a lower prevalence of commonly targetable mutations such as BRAF V600, and are usually diagnosed at a more advanced stage with a poor prognosis. The advent of immunotherapies therefore represents a great stride forward in the treatment of melanoma, including in East Asian countries, with immune checkpoint blockade now available as first-line treatment in China. AREAS COVERED: This review briefly outlines the epidemiology and unique clinical characteristics of melanoma in East Asian patients; summarizes existing immunotherapy approvals, treatment landscape, and unmet needs; and aims to enable clinicians to make more informed treatment decisions for patients. EXPERT OPINION: Further research is urgently needed into novel immunotherapeutic combinations, and biomarkers of response, to fully unlock the potential of immunotherapy for East Asian AM and MM and guide future therapeutic strategies.