Does the presence of a KEAP1 mutation influence your decision to use adjuvant immunotherapy in stage II–III melanoma?

It is an interesting thought when you look at the mutations that may predict resistance to checkpoint inhibitors. However, I do not think we are at a stage where we can make a firm decision in the adjuvant setting (or any other setting) based on mutation profile. If there is a concomitant BRAF mutation present, then I may lean towards a BRAF and MEK inhibitor in the adjuvant setting.

Unfortunately, the data is painfully limited when one has the knowledge of these mutations and what they can do. I would still make my decision based on the stage/risk of recurrence versus potential adverse events and continue surveillance. Perhaps adding ctDNA measurement for a good measure of relapse, although that is also not a perfect science.