Intermediate- and high-risk melanoma |
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Authors: | Agarwala Sanjiv S |
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Institution: | (1) University of Pittsburgh, N-755 MUH 200 Lothrop Street, 15261 Pittsburgh, PA, USA |
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Abstract: | Opinion statement Intermediate and high risk for recurrence melanoma comprise a unique subset of patients with surgically treatable melanoma
for whom cure is possible but relapse and distant metastases likely. Strategies to improve the prognosis for such patients
with effective adjuvant therapies are critical. In recent randomized trials conducted by the cooperative groups in the United
States of patients at high risk for recurrence (patients with thick primary melanomas and those with regional lymph node metastases)
administered adjuvant therapy with high-dose interferon alfa-2b (HDI), relapse-free survival and overall survival rates improved
significantly. Research efforts in this area continue to assess the role of intermediate-dose interferon, but there is no
convincing evidence of success of the lower-dose regimens, despite the reduction in toxicity. For a subset of patients at
highest risk (two or more involved lymph nodes), a regimen of therapy for metastatic stage IV melanoma (interleukin-2 based
biochemotherapy) is being compared with HDI in an ongoing phase III trial. For intermediate-risk melanoma, no effective adjuvant
therapy is available. For such patients, enrollment in ongoing clinical trials assessing the role of shorter courses of HDI
or vaccines should be encouraged. |
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