American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment improves both disease-free and overall survival in stage III resected melanoma?

1. Ipilimumab

2. Nivolumab

3. Targeted therapy with vemurafenib

4. Maintenance therapy with pembrolizumab

The correct answer is: Ipilimumab

Ipilimumab is a monoclonal antibody that functions as a CTLA-4 inhibitor, a type of immune checkpoint inhibitor. In patients with stage III resected melanoma, studies have demonstrated that ipilimumab can significantly improve both disease-free survival and overall survival compared to observation or placebo groups. The efficacy of ipilimumab in this context stems from its ability to enhance the immune response against melanoma cells, thereby reducing the risk of recurrence after resection. While other therapies such as nivolumab, which is a PD-1 inhibitor, and targeted therapy with vemurafenib, a BRAF inhibitor, can also offer significant benefits in specific patient populations, their roles in the context of adjuvant treatment for resected stage III melanoma can vary. Nivolumab may have strengths in advanced melanoma, and targeted therapy is typically more relevant for patients with BRAF V600 mutations. In essence, ipilimumab has been established in clinical trials as a pivotal treatment option that improves outcomes for patients with resected stage III melanoma, making it a vital part of the adjuvant therapy landscape for this disease stage.