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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Update on adjuvant melanoma therapy.

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Nivolumab is now the preferred adjuvant melanoma treatment over ipilimumab due to better efficacy and lower toxicity. Targeted therapies are also effective for BRAF-mutated melanoma, while interferon use is limited.

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Area of Science:

  • Oncology
  • Dermatology
  • Clinical Trials

Background:

  • Adjuvant therapy for high-risk melanoma aims to improve relapse-free survival (RFS) and overall survival (OS) post-resection.
  • Melanoma staging (AJCC 8th edition) considers nodal (N) and tumor (T) criteria, indicating heterogeneous prognoses for stage III patients.

Purpose of the Study:

  • To review clinical trial results and discuss current adjuvant treatment strategies for melanoma.
  • To evaluate the evolving landscape of melanoma adjuvant therapy.

Main Methods:

  • Review of relevant clinical trials in the melanoma adjuvant setting.
  • Analysis of data from randomized, phase-3 clinical trials.

Main Results:

  • Nivolumab demonstrates superior efficacy and reduced toxicity compared to ipilimumab, supporting its substitution in adjuvant therapy regardless of mutation status.
  • For BRAF-mutated melanoma patients, adjuvant dabrafenib and trametinib show sustained high efficacy.
  • Interferon therapy is now reserved for specific cases (ulcerated melanoma) or regions with limited access to newer agents.

Conclusions:

  • Nivolumab represents a new standard of care in the adjuvant melanoma setting.
  • Targeted therapies are highly effective for BRAF-mutated melanoma.
  • Treatment decisions should consider drug access and specific patient characteristics.