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Adjuvant Therapy of Melanoma

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Melanoma

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Abstract

This chapter presents and discusses the historical perspective on adjuvant therapy for surgically resected melanoma.

While doing this, key aspects connected with adjuvant therapy such as the definition of “high-risk” melanoma, which patients would benefit from adjuvant therapy, and how perception of this has developed over time, are also analyzed.

Prognosis of melanoma is heavily dependent upon stage at diagnosis. Within the group thought to benefit from adjuvant treatment, those with “high-risk disease,” stage IIB–IIIC, the prognosis varies greatly. The evolution of stage III melanoma is discussed, as well as the newer tools such as Sentinel Lymph Node biopsies and tumor ulceration as a predictor of disease progression and response to adjuvant therapy.

The pivotal trials that first showed treatment benefit of adjuvant treatment are put into the context of staging techniques used at the time trials were performed.

Trials involving different IFN-α-2b regimens are discussed in depth as well as PEG-IFN-α-2b, with a description of the controversies surrounding both of these adjuvant treatments. The different regimens of interferon utilized in clinical trials, including high dose, low dose, intermediate dose, and pulsed doses, as well as abbreviated regimens are also explored.

Although interferon dominated the field of adjuvant treatment for melanoma for decades, a new treatment option is now available in the CTLA-4 inhibitor Ipilimumab. The trial leading up to FDA approval of this treatment as well as toxicities and side effects are reviewed.

Finally the future of adjuvant therapy of melanoma is considered, with a presentation of ongoing trials involving other checkpoint inhibitors such as the anti PD-1 agents Nivolumab and Pembrolizumab as well as targeted therapy with the BRAF-inhibitors Dabrafenib in combination with the MEK inhibitor Trametinib.

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Authors and Affiliations

  1. Department of Hematology and Oncology, University Health Network, Bethlehem, PA, USA

    Elisabeth Eapen Paul M.D. & Sanjiv S. Agarwala M.D.

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  1. Elisabeth Eapen Paul M.D.
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  2. Sanjiv S. Agarwala M.D.
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  1. Louisiana State University, New Orleans, Louisiana, USA

    Adam I. Riker

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Paul, E.E., Agarwala, S.S. (2018). Adjuvant Therapy of Melanoma. In: Riker, A. (eds) Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-78310-9_29

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