(Neo)adjuvant systemic therapy for melanoma

Abstract

Surgery still is the cornerstone of treatment for patients with stage II and III melanoma, but despite great efforts to gain or preserve locoregional control with excision of the primary tumour, satellites, intransits, sentinel node biopsy and lymphadenectomy, surgery alone does not seem to improve survival any further. Prognosis for patients with high risk melanoma remains poor with 5-year survival rates of 40 to 80%. Only interferon-2b has been approved as adjuvant therapy since 1995, but clinical integration is low considering the high risk-benefit ratio. In recent years systemic targeted- and immunotherapy have proven to be beneficial in advanced melanoma and could be a promising strategy for (neo)adjuvant treatment of patients with resectable high risk melanomas as well. Randomised, placebo- controlled phase III trials on adjuvant systemic targeted- and immunotherapy are currently being performed using new agents like ipilimumab, pembrolizumab, nivolumab, vemurafenib and dabrafenib plus trametinib. In this article we review the literature on currently known adjuvant therapies and currently ongoing trials of (neo)adjuvant therapies in high risk melanomas.

Keywords: Adjuvant; Anti CTLA-4; Anti PD1; BRAF inhibitor; Cobimetinib; Cutaneous melanoma; Dabrafenib; High risk melanoma; Immunotherapy; Ipilimumab; MEK inhibitor; Melanoma; Neoadjuvant; Review; T-VEC; Tamilogene Laherparepvec; Trametinib; Vemurafenib.