Adjuvant therapy for stage II melanoma: the need for further studies
- Author(s)
- Lee, R; Mandala, M; Long, GV; Eggermont, AMM; van Akkooi, ACJ; Sandhu, S; Garbe, C; Lorigan, P;
- Journal Title
- European Journal of Cancer
- Publication Type
- Review
- 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.
- Publisher
- Elsevier
- Keywords
- Humans; Nivolumab; Neoplasm Recurrence, Local; *Melanoma/drug therapy/pathology; *Skin Neoplasms/pathology; Adjuvant therapy; Clinical trials; Stage II melanoma
- Department(s)
- Medical Oncology
- PubMed ID
- 37301717
- Publisher's Version
- https://doi.org/10.1016/j.ejca.2023.05.003
- Open Access at Publisher's Site
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Creation Date: 2023-10-03 06:39:58
Last Modified: 2023-10-04 12:44:04