Adjuvant therapy for stage II melanoma: the need for further studies.

Publication date: Aug 01, 2023

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.

Concepts Keywords
Immunotherapy Adjuvant therapy
Molecular Clinical trials
Newer Stage II melanoma


Type Source Name
disease MESH melanoma
pathway KEGG Melanoma
drug DRUGBANK Nivolumab
drug DRUGBANK Ipilimumab
drug DRUGBANK Pembrolizumab
drug DRUGBANK Dabrafenib
drug DRUGBANK Trametinib
disease MESH metastasis
disease MESH morbidity
drug DRUGBANK Tropicamide

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