Point: Interferon-alpha for adjuvant therapy for melanoma patients

Interferon-alpha is possibly the most controversial adjuvant therapy for any solid tumor, and multiple trials involving varying doses, routes, schedules, and formulations of interferon-alpha have increased the confusion. Clinicians are left in a quandary, because high-dose interferon-alpha-2b (HDI) remains the only FDA-approved adjuvant therapy for high-risk melanoma. Of the three prospective randomized trials involving high-dose interferon-alpha-2b, all show a significant improvement in disease-free survival and two show a significant improvement in overall survival. Despite this strong evidence, data from studies involving alternate doses, concerns regarding cost and toxicity, and the promise of future therapies have led opponents of interferon to overlook these results. Based on the available clinical evidence, however, high-dose interferon should be offered as standard care for patients with high-risk, resected melanoma. Informed patients who have elected to forego interferon and patients with lower risk lesions can be offered participation in clinical trials with a no-treatment control arm.