Exploring Advancements and Challenges in Adjuvant Melanoma Treatment

Abstract

Melanoma of the skin is a common type of cancer that primarily affects younger patients. In Stage III melanoma, which does not involve distant metastases, radical resection is curative in 40–50% of the cases. Adjuvant therapy should be discussed with suitable patients, as it can decrease the chance of, or extend the time to, relapse. Such therapies include mitogen-activated protein kinase (MEK), B-Raf proto-oncogene (BRAF), or serine/threonine kinase inhibitors, and immunotherapies against programmed death 1 (PD-1). These agents have significantly improved relapse-free survival (RFS) rates compared with placebo. However, adverse events (AE) associated with these treatments, although predominantly treatable at the time, may have longer-term consequences in some cases, including as yet unknown impacts on fertility. Three experts in the field of melanoma discussed with EMJ some of the issues around utilising adjuvant therapies for patients with resected Stage III disease. They highlighted the importance of including in the initial patient consultation not only information on survival outcomes, but also potential AEs, practical considerations regarding therapy choice, the impact of therapy on quality of life (QoL), and the possible need for cryopreservation, given the potential impact of these therapies on fertility. The experts also discussed the need to develop biomarkers that could help identify which patients may derive most benefit from adjuvant therapy, and those more likely to experience AEs. Awareness of both the advantages of adjuvant therapy, and short- and long-term impacts on health-related QoL (HRQoL), can help when discussing therapy choice with a patient.