Adjuvant therapy refers to the use of chemotherapy, targeted therapy, immunotherapy or radiotherapy in addition to surgical resection in the treatment of cancer. Five-year survival rates in patients with resected stage III melanoma have ranged from 39% to 70 % in patients with stage IIIA-IIIC disease. The goal of adjuvant therapy is to improve the survival and control the cancer in patients with stage III and IV disease. Further discussion with the oncologist will help in determining if adjuvant therapy is indicated or is beneficial to you.
Interferon alfa-2b is one of the FDA approved drugs in the adjuvant treatment of malignant melanoma. Both high-dose IFN-alpha-2b and pegylated IFN-alpha-2b have demonstrated improved relapse-free or disease-free survival in randomized clinical trials. However, improvement in overall survival has been inconsistent across trials.
Targeted therapy is a form of treatment that takes advantage of certain genetic differences in the tumor with the goal of destroying cancer cells while leaving normal cells intact. A targeted therapy may be more effective compared to chemotherapy or radiotherapy in management of certain cancers. B-Raf V600 mutation is found in about 50% of patients with metastatic melanoma, and it is one of the most common mutations identified to date. Vemurafenib is one of the targeted therapeutic drugs in this class that has been approved for the management of melanoma. Currently certain combination of drugs has shown to be more effective than a single drug in the management of melanoma.
In recent years, immune checkpoint inhibitor antibodies have shown to improve the clinical outcomes for patients with advanced melanoma. Immunotherapy attempts to activate the person’s immune system to destroy melanoma cells in the body. Ipilimumab targets the cytotoxic T lymphocyte-associated protein 4 (CTLA-4) receptor and other drugs such as Nivolumab and pembrolizumab target programmed cell death protein 1 (PD-1) receptors and have proven to improve progression free survival.
Response rates following chemotherapy in the treatment of metastatic melanoma have been somewhat disappointing. Radiotherapy has been used with some success in high risk lesions following surgery to improve the local control of the tumor with limited survival benefit.
This field has rapidly evolved since 2012, and there are a number of clinical trials open currently evaluating the combination of treatments and other newer agents. Your oncologist will be able to further discuss the risks and benefits of above mentioned treatment options and tailor the treatment for you.