Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma
AffiliationNetherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
MetadataShow full item record
AbstractWide local excision is considered routine therapy after initial diagnosis of primary melanoma to reduce local recurrences, but it does not impact survival. Sentinel node staging is recommended for melanomas of intermediate thickness, but it has also not demonstrated any indisputable therapeutic effect on survival. The prognostic value of sentinel node staging has been long established and is therefore considered routine, especially in light of the eligibility criteria for adjuvant therapy (trials). Whether completion lymph node dissection after a positive sentinel node biopsy improves survival is the question of current trials. The MSLT-2 study is best powered to show a potential benefit, but it has not yet reported any data. Another study, the German DECOG study, presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting did not show any benefit but is criticized for the underpowered design and insufficient follow-up. There is no consensus on the use of adjuvant interferon in melanoma. This topic has been the focus of many studies with different regimens (low-, intermediate-, or high-dose and/or short- or long-term treatment). Adjuvant interferon has been shown to improve relapse-free survival but failed to improve overall survival. More recently, adjuvant ipilimumab has also demonstrated an improved relapse-free survival. Overall survival data have not yet been reported due to insufficient follow-up. Currently, studies are ongoing to analyze the use of adjuvant anti-PD-1 and molecular targeted therapies (vemurafenib, dabrafenib, and trametinib). In the absence of unambiguously positive approved agents, clinical trial participation remains a priority. This could change in the near future.
Citationvan Akkooi ACJ, Atkins MB, Agarwala SS, Lorigan P. Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma. American Society of Clinical Oncology Educational Book. 2016 May;(36):e505�14.
JournalAm Soc Clin Oncol Educ Book
- The extent of surgery for stage III melanoma: how much is appropriate?
- Authors: Franke V, van Akkooi ACJ
- Issue date: 2019 Mar
- [Stage III melanoma: Sentinel node biopsy, completion lymph node dissection and prospects of adjuvant therapy. A French national survey on current and envisaged practices].
- Authors: Orion C, Dinulescu M, Dalac-Rat S, Giacchero D, Jouary T, Lebbé C, Leccia MT, Maubec E, Meyer N, Mortier L, Dupuy A, Groupe de cancérologie cutanée de la Société française de dermatologie.
- Issue date: 2020 Jan
- Adjuvant ipilimumab in stage III melanoma: New landscape, new questions.
- Authors: Eggermont AM
- Issue date: 2016 Dec
- The 2017 complete overhaul of adjuvant therapies for high-risk melanoma and its consequences for staging and management of melanoma patients.
- Authors: Eggermont AMM, Dummer R
- Issue date: 2017 Nov
- Adjuvant therapy for resected stage III melanoma patients: high-dose interferon-alpha versus ipilimumab combined with kinases inhibitors.
- Authors: Minutilli E, Feliciani C
- Issue date: 2012 Mar-Apr