Adjuvant Therapy in Acral Melanoma: A Systematic Review

Area of Science:

• Oncology
• Dermatology
• Clinical Trials

Background:

• Acral melanoma exhibits unique biological features distinct from cutaneous melanoma.
• Adjuvant therapy for high-risk acral melanoma mirrors cutaneous melanoma strategies, but evidence is limited.
• Existing adjuvant therapies for acral melanoma require systematic efficacy and safety analysis.

Purpose of the Study:

• To systematically review the efficacy and safety of adjuvant therapies in acral melanoma.
• To evaluate outcomes of interferon, anti-PD-1, and targeted therapies in acral melanoma patients.

Main Methods:

• Systematic review adhering to a pre-registered protocol.
• Comprehensive search of four electronic databases and reference lists.
• Primary outcome: therapeutic efficacy; Secondary outcome: adverse events.

Main Results:

• Eleven studies involving 758 patients were analyzed.
• High-dose interferon α-2b (IFN) showed no significant difference in recurrence-free survival (RFS) but increased hepatotoxicity.
• Adjuvant anti-PD-1 therapy demonstrated variable efficacy, with improved RFS linked to immune-related adverse events (AEs).
• Targeted therapy (dabrafenib plus trametinib) showed high 12-month RFS in BRAF-mutated acral melanoma.
• Anti-PD-1 therapy appears comparable to IFN for high-risk acral melanoma; prior pegylated IFN enhanced pembrolizumab efficacy.

Conclusions:

• High-dose IFN, while common, has significant AEs, driving the need for alternatives.
• Adjuvant anti-PD-1 therapy is a promising alternative but may be less effective than in non-acral melanoma.
• Further prospective studies are essential to establish optimal adjuvant treatment protocols for acral melanoma.