2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Reprinted by permission of Eur J Cancer. 2017; 86:101-105.

European Journal of Cancer 86 (2017) 101 e 105

Available online at www.sciencedirect.com ScienceDirect

journal homepage: www.ejcancer.com

Current Perspective

The 2017 complete overhaul of adjuvant therapies for high-risk melanoma and its consequences for staging and management of melanoma patients

Alexander M.M. Eggermont a , b , * , Reinhard Dummer c

a Gustave Roussy Cancer Campus Grand Paris, Villejuif, France b Universite Paris-Sud, Kremlin-Biceˆtre, France c University Hospital Zu¨rich, Department of Dermatology, Zu¨rich, Switzerland

Received 18 September 2017; accepted 18 September 2017 Available online 29 September 2017

Abstract The spectacular outcomes of the phase III trials regarding nivolumab versus ipili- mumab in fully resected stage IIIB/C e IV and of the combination of dabrafenib (D) plus tra- metinib (T) in BRAF-mutant stage III patients demonstrate that effective treatments in advanced melanoma are also highly effective in the adjuvant setting. In 2016, an overall sur- vival benefit with adjuvant high-dose ipilimumab was demonstrated, and the European Orga- nisation for Research and Treatment of Cancer trial 1325 comparing pembrolizumab versus placebo will complete the picture in the early 2018. Toxicity profiles are in line with the expe- rience in advanced melanoma, i.e. favourable for the anti-PD1 agents and for D þ T and prob- lematic for ipilimumab. The 2017 outcomes are practice changing and put an end to the use of interferon (IFN) and ipilimumab. In countries with only access to IFN, its use can be restricted to patients with ulcerated melanoma, based on the individual patient data meta- analysis recently published. Because of the results of the Melanoma Sentinel Lymph node Trial-2 (MSLT-2) trial, completion lymph node dissection (CLND) will decrease sharply, lead- ing to a lack of optimal prognostic information. Prognosis in sentinel node e positive stage IIIA/B patients is extremely heterogeneous with 5-year survival rates varying from 90% to 40% and depends mostly on the number of positive nodes identified by CLND. This informa- tion is crucial for clinical decision-making. How to guarantee optimal staging information

KEYWORDS Melanoma;

Adjuvant therapy; Randomised trials;

Nivolumab; Ipilimumab; Dabrafenib; Trametinib

* Corresponding author : Gustave Roussy Cancer Institute and University Paris-Sud, 114 Rue Edouard Vaillant 94805 Villejuif, France. Fax: þ 33 1 42 11 52 52. E-mail address: alexander.eggermont@gustaveroussy.fr (A.M.M. Eggermont).

https://doi.org/10.1016/j.ejca.2017.09.014 0959-8049/ ª 2017 Elsevier Ltd. All rights reserved.

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