Journal
EJSO
Volume 43, Issue 3, Pages 534-543Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2016.07.001
Keywords
Cutaneous melanoma; High risk melanoma; Melanoma; Adjuvant; Neoadjuvant; Immunotherapy; Anti CTLA-4; Ipilimumab; BRAF inhibitor; Vemurafenib; Dabrafenib; MEK inhibitor; Trametinib; Cobimetinib; Arid PD1; T-VEC; Tamilogene Laherparepvec; Review
Funding
- Bristol-Myers Squibb
- Merck Sharp Dohme
- Glaxo Smith Kline
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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. (C) 2016 Elsevier Ltd, BASO similar to the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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