Adjuvant Treatment for Stage III Melanoma in the Era of Targeted Medicine and Immunotherapy

Abstract

The accelerated development in the treatment of metastatic melanoma, both in molecular targeted therapy and immunotherapy, is already starting to impact on adjuvant therapy in stage III melanoma. Following the approval of ipilimumab for adjuvant therapy in melanoma, clinical trials assessing other checkpoint modulators and MAPK pathway inhibitors as adjuvant treatments for melanoma are currently ongoing. As results from these trials mature in the next few years, a change in the landscape of adjuvant treatment for melanoma is expected, resulting in new challenges in treatment decisions such as optimizing patients selection through predictive and prognostic biomarkers, and management of treatment related adverse events, in particular immune related toxicities.

Safety profile and clinical outcome of adjuvant radiation therapy and intermediate-dose interferon in comparison with intermediate-dose interferon alone in patients with melanoma metastases in regional lymph nodes and unfavorable prognostic factors

“…Melanoma preferentially metastasizes to lymph nodes, leading to hypotheses that it spreads through the lymphatic vasculature [3]. Surgery is the standard of care for localized melanoma and regional lymph node metastases, but patients with stage III (T1-4N1-3M0) disease are at high risk of relapse after definitive surgery [4] so they need treatment in the adjuvant setting to prevent distant metastases [5]. The risk of disease progression increases in the presence of some unfavorable prognostic factors (more than three lymph nodes metastases and/or extracapsular tumor spreading).…”