Adjuvant therapy for stage II melanoma: the need for further studies
Lee, Rebecca J Mandala, M. Long, G. V. Eggermont, A. M. M. van Akkooi, A. C. J. Sandhu, S. Garbe, C.
Lee, Rebecca J
Mandala, M.
Long, G. V.
Eggermont, A. M. M.
van Akkooi, A. C. J.
Sandhu, S.
Garbe, C.
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Abstract
Immunotherapy with checkpoint inhibitors has revolutionised the outcomes for melanoma patients. In the metastatic setting, patients treated with nivolumab and ipilimumab have an expected 5-year survival of> 50%. For patients with resected high-risk stage III disease, adjuvant pembrolizumab, nivolumab or dabrafenib and trametinib are associated with a significant improvement in both relapse-free survival (RFS) and distant metastasis-free survival (DMFS). More recently neoadjuvant immunotherapy has shown very promising outcomes in patients with clinically detectable nodal disease and is likely to become a new standard of care. For stage IIB/C disease, two pivotal adjuvant trials of pembrolizumab and nivolumab have also reported a significant improvement in both RFS and DMFS. However, the absolute benefit is low and there are concerns about the risk of severe toxicities as well as long-term morbidity from endocrine toxicity. Ongoing registration phase III trials are currently evaluating newer immunotherapy combinations and the role of BRAF/MEK-directed targeted therapy for stage II melanoma. However, our ability to personalise therapy based on molecular risk stratification has lagged behind the development of novel immune therapies. There is a critical need to evaluate the use of tissue and blood-based biomarkers, to better select patients that will recur and avoid unnecessary treatment for the majority of patients cured by surgery alone.
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Date
2023
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Collections
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Article
Citation
Lee R, Mandala M, Long GV, Eggermont AMM, van Akkooi ACJ, Sandhu S, et al. Adjuvant therapy for stage II melanoma: the need for further studies. European journal of cancer (Oxford, England : 1990). 2023 May 8:112914. PubMed PMID: 37301717. Epub 2023/06/11. eng.