The Adjuvant Treatment of Cutaneous Melanoma Just Became Interesting
Abstract
Until recently, melanoma was a very challenging cancer to treat. The only adjuvant therapy available for years was interferon, which was associated with significant toxicity. Advances in metastatic melanoma, namely the development of immunotherapies and targeted therapies, have rapidly changed the standard of care for patients with advanced or high risk local disease.
Ipilimumab was the first immunotherapy approved after demonstrating a relapse free survival (RFS) of 26.1 months compared to 17.1 months with placebo, and subsequently demonstrated a 10% difference in overall survival at 5 years, although with significant toxicity. Nivolumab and now pembrolizumab have also demonstrated prolonged RFS by about 10% at one year, with a hazard ratio for each around 0.55, each with much lower toxicity than ipilimumab. Targeted therapy combinations with the BRAF and MEK inhibitors dabrafenib and trametinib have shown a 20% improvement in median RFS at 18 months with hazard ratio of 0.47. The introduction of novel classes of therapy in the adjuvant setting has shown dramatic improvement in toxicity, tolerability, and survival. This has changed the standard of therapy for adjuvant melanoma and raised additional questions on overall patient management.
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DOI: http://dx.doi.org/10.18103/imr.v4i7.736
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