Adjuvant strategies for high-risk melanoma

作者：Fluck M; Garbe C^*

来源：Onkologe, 2014, 20(6): 555-567.

DOI：10.1007/s00761-013-2525-x

• Melanoma
• Interferons
• Ipilimumab
• MAGE-A3 protein
• human
• Inhibitors

For high-risk melanoma in stages II and III (thick primary tumors > 2 mm tumor thickness and presence of locoregional metastases) there is a need for adjuvant therapy to reduce the recurrence and mortality risk.
A literature search was performed in PubMed. Current adjuvant trials involving high-risk melanoma patients in Europe were identified in the database ClinicalTrials.gov.
Several randomized phase III studies have been conducted to find a successful adjuvant therapy. Studies with systemic chemotherapy and with nonspecific immunostimulants, such as Bacillus Calmette-Gu,rin (BCG) vaccination or mistletoe therapy were ineffective. An improvement of recurrence-free and overall survival was demonstrated in the 1990s only for interferon alpha therapy and a high-dose regimen was approved in the USA and Europe as well as a low-dose regimen in Europe. In Germany the low-dose regimen is mainly offered to stage II and III melanoma patients; however, the clinical benefit of this treatment is moderate and new trials are currently looking for more effective adjuvant therapies for melanoma. A European Organisation for Research and Treatment of Cancer (EORTC) study with the monoclonal cytotoxicT-lymphocyte antigen 4 (CTLA-4) antibody ipilimumab has already been completed in the recruitment stage, as well as a cancer vaccination study with the recombinant melanoma-associated antigen 3 (MAGE-A3) and a study with the anti-angiogenic antibody bevacizumab. Furthermore, two studies were launched with kinase inhibitors, a study with the BRAF inhibitor vemurafenib and a study with the combination of the BRAF inhibitor dabrafenib and the mitogen-activated protein kinase (MEK) inhibitor trametinib.
It remains to be seen whether one or more of these treatments will show better efficacy than interferon alpha, and whether changes in the adjuvant therapy of melanoma will prevail in the coming years.

• 出版日期2014-6