What systemic therapy would you offer a patient with metastatic melanoma who is BRAF WT and developed metastases while on adjuvant nivolumab?  

Adding an anti-CTLA4 agent after progression on anti-PD1 (even in the adjuvant setting) should be a reasonable choice for patients who are ineligible for clinical trials. In our practice, we recommend using the CheckMate 067 dose (Ipi 3 and Nivo 1) when faced with such a situation. Zimmer et al., PM...

I agree with ipi/nivo, but I prefer a clinical trial if available. For patients with bulky recurrence that progresses quickly, I would treat with BRAF inhibitors, and transition to ipi/nivo within the next 2 to 3 weeks. We keep a supply of dabrafenib/binimetinib or vemurafenib in our pharmacy for p...