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Adjuvant Therapy of Melanoma

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Melanoma

Part of the book series: Cancer Treatment and Research ((CTAR,volume 167))

Abstract

The incidence of melanoma is rapidly increasing, especially in younger female and older male patients. Recent fundamental advances in our knowledge of melanoma tumorigenesis have established roles for inhibitors of the MAPK pathway and regulatory immune checkpoints CTLA-4 and PD-1/PD-L1. However, the majority of patients continue to present with non-metastatic disease—typically managed with surgical resection and adjuvant therapy. High-dose IFN-α2b (HDI) is the main adjuvant therapeutic mainstay in high-risk disease following definitive resection. In this chapter, we review the evidence supporting the use of adjuvant HDI in high-risk melanoma. We also discuss some of the other treatment modalities that have been evaluated including vaccines, chemotherapy, and radiotherapy.

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References

  1. Surveillance, Epidemiology, and End Results Program. Turning Cancer Data into Discovery. Melanoma of the Skin. Date last modified not known. Available at: http://seer.cancer.gov/statfacts/html/melan.html. Accessed 01 Mar 2014

  2. National Cancer Institute: PDQ® Melanoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified 16 May 2013. Available at: http://cancer.gov/cancertopics/pdq/treatment/melanoma/HealthProfessional. Accessed 01 Mar 2014

  3. Balch CM, Gershenwald JE, Soong SJ et al (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27(36):6199–6206

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kettlewell S, Moyes C, Bray C et al (2006) Value of sentinel node status as a prognostic factor in melanoma: prospective observational study. BMJ 332:1423

    Article  PubMed Central  PubMed  Google Scholar 

  5. van Akkooi AC, de Wilt JH, Verhoef C, Eggermont AM (2008) Isolated tumor cells and long-term prognosis of patients with melanoma. Ann Surg Oncol 15(5):1547–1548

    Article  PubMed Central  PubMed  Google Scholar 

  6. Liew DN, Kano H, Kondziolka D et al (2011) Outcome predictors of gamma knife surgery for melanoma brain metastases: Clinical article. J Neurosurg 114(3):769–779

    Article  PubMed  Google Scholar 

  7. Melanoma Nomogram: Sentinel Node Metastasis. Date last modified unknown. Available at: http://www.mskcc.org/cancer-care/adult/melanoma/prediction-tools. Accessed 01 Mar 2014

  8. Individualized Melanoma Patient Outcome Prediction Tools—developed based on the AJCC Melanoma Database. Date last modified unknown. Available at: http://www.melanomaprognosis.org/. Accessed 01 Mar 2014

  9. Creagan ET, Dalton RJ, Ahmann DL et al (1995) Randomized, surgical adjuvant clinical trial of recombinant interferon alfa-2a in selected patients with malignant melanoma. J Clin Oncol 13(11):2776–2783

    CAS  PubMed  Google Scholar 

  10. Kirkwood JM, Strawderman MH, Ernstoff MS et al (1996) Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol 14(1):7–17

    CAS  PubMed  Google Scholar 

  11. Kirkwood JM, Ibrahim JG, Sondak VK et al (2000) High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol 18(12):2444–2458

    CAS  PubMed  Google Scholar 

  12. Kirkwood JM, Ibrahim JG, Sosman JA et al (2001) High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol 19(9):2370–2380

    CAS  PubMed  Google Scholar 

  13. Kirkwood JM, Ibrahim J, Lawson DH et al (2001) High-dose interferon alfa-2b does not diminish antibody response to GM2 vaccination in patients with resected melanoma: results of the Multicenter Eastern Cooperative Oncology Group Phase II Trial E2696. J Clin Oncol 19(5):1430–1436

    CAS  PubMed  Google Scholar 

  14. Pectasides D, Dafni U, Bafaloukos D et al (2009) Randomized phase III study of 1 month versus 1 year of adjuvant high-dose interferon alfa-2b in patients with resected high-risk melanoma. J Clin Oncol 27(6):939–944

    Article  CAS  PubMed  Google Scholar 

  15. Chiarion-Sileni V, Guida M, Romanini A et al (2011) Intensified high-dose intravenous interferon alpha 2b (IFNa2b) for adjuvant treatment of stage III melanoma: a randomized phase III Italian Melanoma Intergroup (IMI) trial [ISRCTN75125874]. J Clin Oncol 29 (suppl; abstr 8506)

    Google Scholar 

  16. Agarwala SS, Lee SJ, Flaherty LE et al (2011) Randomized phase III trial of high-dose interferon alfa-2b for 4 weeks induction only in patients with intermediate- and high-risk melanoma (Intergroup trial E 1697). J Clin Oncol 29(suppl; abstr 8505)

    Google Scholar 

  17. Eggermont AM, Suciu S, MacKie R et al (2005) Post-surgery adjuvant therapy with intermediate doses of interferon alfa 2b versus observation in patients with stage IIb/III melanoma (EORTC 18952): randomised controlled trial. Lancet 366(9492):1189–1196

    Article  CAS  PubMed  Google Scholar 

  18. Eggermont AM, Suciu S, Testori A et al (2012) Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma. J Clin Oncol 30(31):3810–3818

    Article  CAS  PubMed  Google Scholar 

  19. Hansson J, Aamdal S, Bastholt L et al (2011) Two different durations of adjuvant therapy with intermediate-dose interferon alfa-2b in patients with high-risk melanoma (Nordic IFN trial): a randomised phase 3 trial. Lancet Oncol 12(2):144–152

    Article  CAS  PubMed  Google Scholar 

  20. Pehamberger H, Soyer HP, Steiner A et al (1998) Adjuvant interferon alfa-2a treatment in resected primary stage II cutaneous melanoma. Austrian Malignant Melanoma Cooperative Group. J Clin Oncol 16(4):1425–1429

    CAS  PubMed  Google Scholar 

  21. Grob JJ, Dreno B, de la Salmonière P et al (1998) Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. French Cooperative Group on Melanoma. Lancet 351(9120):1905–1910

    Article  CAS  PubMed  Google Scholar 

  22. Cascinelli N, Belli F, MacKie RM et al (2001) Effect of long-term adjuvant therapy with interferon alpha-2a in patients with regional node metastases from cutaneous melanoma: a randomised trial. Lancet 358(9285):866–869

    Article  CAS  PubMed  Google Scholar 

  23. Cameron DA, Cornbleet MC, Mackie RM et al (2001) Adjuvant interferon alpha 2b in high risk melanoma—the Scottish study. Br J Cancer 84(9):1146–1149

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Kleeberg UR, Suciu S, Bröcker EB et al (2004) Final results of the EORTC 18871/DKG 80-1 randomised phase III trial. rIFN-α2b versus rIFN-gamma versus ISCADOR M versus observation after surgery in melanoma patients with either high-risk primary (thickness >3 mm) or regional lymph node metastasis. Eur J Cancer 40(3):390–402

    Article  CAS  PubMed  Google Scholar 

  25. Hancock BW, Wheatley K, Harris S et al (2004) Adjuvant interferon in high-risk melanoma: the AIM HIGH Study-United Kingdom Coordinating Committee on Cancer Research randomized study of adjuvant low-dose extended-duration interferon Alfa-2a in high-risk resected malignant melanoma. J Clin Oncol 22(1):53–61

    Article  CAS  PubMed  Google Scholar 

  26. Garbe C, Radny P, Linse R et al (2008) Adjuvant low-dose interferon α2a with or without dacarbazine compared with surgery alone: a prospective-randomized phase III DeCOG trial in melanoma patients with regional lymph node metastasis. Ann Oncol 19(6):1195–1201

    Article  CAS  PubMed  Google Scholar 

  27. Hauschild A, Weichenthal M, Rass K et al (2010) Efficacy of low-dose interferon α2a 18 versus 60 months of treatment in patients with primary melanoma of ≥1.5 mm tumor thickness: results of a randomized phase III DeCOG trial. J Clin Oncol 28(5):841–846

    Article  CAS  PubMed  Google Scholar 

  28. Flaherty LE, Othus M, Atkins MB, et al (2014) Southwest Oncology Group S0008: a phase III trial of high-dose interferon Alfa-2b versus cisplatin, vinblastine, and dacarbazine, plus interleukin-2 and interferon in patients with high-risk melanoma–an intergroup study of cancer and leukemia Group B, Children’s Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. J Clin Oncol 32(33):3771–3778

    Google Scholar 

  29. Lens MB, Dawes M (2002) Interferon alfa therapy for malignant melanoma: a systematic review of randomized controlled trials. J Clin Oncol 20:1818–1825

    Article  CAS  PubMed  Google Scholar 

  30. Mocellin S, Lens MB, Pasquali S et al (2013) Interferon alpha for the adjuvant treatment of cutaneous melanoma. Cochrane Database Syst Rev 6:CD008955

    Google Scholar 

  31. Wheatley K, Hancock B, Gore M et al (2007) Interferon-α as adjuvant therapy for melanoma: an individual patient data meta-analysis of randomised trials. J Clin Oncol 25(suppl 18): Abstract 8526

    Google Scholar 

  32. Wheatley K, Ives N, Hancock B et al (2003) Does adjuvant interferon-alpha for high-risk melanoma provide a worthwhile benefit? A meta-analysis of the randomised trials. Cancer Treat Rev 29:241–252

    Article  CAS  PubMed  Google Scholar 

  33. Mocellin S, Pasquali S, Rossi CR et al (2010) Interferon alpha adjuvant therapy in patients with high-risk melanoma: a systematic review and meta analysis. J Natl Cancer Inst 102:493–501

    Article  CAS  PubMed  Google Scholar 

  34. Payne MJ, Argyropoulou K, Lorigan P et al (2014) Phase II pilot study of intravenous high-dose interferon with or without maintenance treatment in melanoma at high risk of recurrence. J Clin Oncol 32(3):185–190

    Article  CAS  PubMed  Google Scholar 

  35. Garbe C, Eigentler TK, Keilholz U et al (2011) Systematic review of medical treatment in melanoma: current status and future prospects. Oncologist 16(1):5–24

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Blanchard T, Srivastava PK, Duan F (2013) Vaccines against advanced melanoma. Clin Dermatol 31(2):179–190

    Google Scholar 

  37. The Investigational MAGE-A3 Antigen-specific Cancer Immunotherapeutic Does Not Meet First Co-primary Endpoint in Phase III Melanoma Clinical Trial. N.p., 5 Sept 2013. Web. 3 Apr 2014

    Google Scholar 

  38. Vical Phase 3 Trial of Allovectin® Fails to Meet Efficacy Endpoints. N.p., 12 Aug 2013. Web. 3 Apr 2014

    Google Scholar 

  39. Hill GJ II, Moss SE, Golomb FM et al (1981) DTIC and combination therapy for melanoma: III. DTIC (NSC 45388) Surgical Adjuvant Study COG PROTOCOL 7040. Cancer 47(11):2556–2562

    Google Scholar 

  40. Veronesi U, Adamus J, Aubert C et al (1982) A randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous melanoma. N Engl J Med 307(15):913–916

    Article  CAS  PubMed  Google Scholar 

  41. Agarwala SS, Neuberg D, Park Y, Kirkwood JM (2004) Mature results of a phase III randomized trial of bacillus Calmette-Guerin (BCG) versus observation and BCG plus dacarbazine versus BCG in the adjuvant therapy of American Joint Committee on Cancer Stage I-III melanoma (E1673): a trial of the Eastern Oncology Group. Cancer 100(8):1692–1698

    Article  CAS  PubMed  Google Scholar 

  42. Atkins MB, Hsu J, Lee S et al (2008) Phase III trial comparing concurrent biochemotherapy with cisplatin, vinblastine, dacarbazine, interleukin-2, and interferon α-2b with cisplatin, vinblastine, and dacarbazine alone in patients with metastatic malignant melanoma (E3695): a trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 26(35):5748–5754

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Flaherty LE, Moon J, Atkins MB et al (2012) Phase III trial of high-dose interferon α-2b versus cisplatin, vinblastine, DTIC plus IL-2 and interferon in patients with high-risk melanoma (SWOG S0008): an intergroup study of CALGB, COG, ECOG, and SWOG. J Clin Oncol 30(suppl; abstr 8504)

    Google Scholar 

  44. Curtin JA, Busam K, Pinkel D, Bastian BC (2006) Somatic activation of KIT in distinct subtypes of melanoma. J Clin Oncol 24(26):4340–4346

    Article  CAS  PubMed  Google Scholar 

  45. Handolias D, Salemi R, Murray W et al (2010) Mutations in KIT occur at low frequency in melanomas arising from anatomical sites associated with chronic and intermittent sun exposure. Pigm Cell Melanoma Res 23(2):210–215

    Article  CAS  Google Scholar 

  46. Kong Y, Si L, Zhu Y et al (2011) Large-scale analysis of KIT aberrations in Chinese patients with melanoma. Clin Cancer Res 17(7):1684–1691

    Article  CAS  PubMed  Google Scholar 

  47. Lian B, Si L, Cui C et al (2013) Phase II randomized trial comparing high-dose IFN-α2b with temozolomide plus cisplatin as systemic adjuvant therapy for resected mucosal melanoma. Clin Cancer Res 19(16):4488–4498

    Article  CAS  PubMed  Google Scholar 

  48. Sause WT, Cooper JS, Rush S et al (1991) Fraction size in external beam radiation therapy in the treatment of melanoma. Int J Radiat Oncol Biol Phys 20(3):429–432

    Article  CAS  PubMed  Google Scholar 

  49. Henderson MA, Burmeister B, Ainslie J et al (2013) Adjuvant radiotherapy after lymphadenectomy in melanoma patients: final results of an intergroup randomized trial (ANZMTG 0.1.02/TROG 02.01). J Clin Oncol 31 (suppl; abstr 9001)

    Google Scholar 

  50. Davies H, Bignell GR, Cox C et al (2002) Mutations of the BRAF gene in human cancer. Nature 417(6892):949–954

    Article  CAS  PubMed  Google Scholar 

  51. Maldonado JL, Fridlyand J, Patel H et al (2003) Determinants of BRAF mutations in primary melanomas. J Natl Cancer Inst 95(24):1878–1890

    Article  CAS  PubMed  Google Scholar 

  52. Wan PT, Garnett MJ, Roe SM et al (2004) Mechanism of activation of the RAF-ERK signaling pathway by oncogenic mutations of B-RAF. Cell 116(6):855–867

    Article  CAS  PubMed  Google Scholar 

  53. Curtin JA, Fridlyand J, Kageshita T et al (2005) Distinct sets of genetic alterations in melanoma. N Engl J Med 353(20):2135–2147

    Article  CAS  PubMed  Google Scholar 

  54. Rubinstein JC, Sznol M, Pavlick AC et al (2010) Incidence of the V600 K mutation among melanoma patients with BRAF mutations, and potential therapeutic response to the specific BRAF inhibitor PLX4032. J Transl Med 14(8):67

    Article  Google Scholar 

  55. Lovly CM, Dahlman KB, Fohn LE et al (2012) Routine multiplex mutational profiling of melanomas enables enrollment in genotype-driven therapeutic trials. PLoS ONE 7(4):e35309

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Chapman PB, Hauschild A, Robert C et al (2011) Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 364(26):2507–2516

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Sosman JA, Kim KB, Schuchter L et al (2012) Survival in BRAF V600-mutant advanced melanoma treated with vemurafenib. N Engl J Med 366(8):707–714

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Flaherty KT, Infante JR, Daud A et al (2012) Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med 367(18):1694–1703

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Parry RV, Chemnitz JM, Frauwirth KA et al (2005) CTLA-4 and PD-1 receptors inhibit T-cell activation by distinct mechanisms. Mol Cell Biol 25(21):9543–9553

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Hodi FS, O’Day SJ, McDermott DF et al (2010) Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 363:711–723

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Robert C, Thomas L, Bondarenko I et al (2011) Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med 364:2517–2526

    Article  CAS  PubMed  Google Scholar 

  62. Wolchok JD, Hoos A, O’Day S et al (2009) Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res 15:7412–7420

    Article  CAS  PubMed  Google Scholar 

  63. Eggermont AM, Chiarion-Sileni V, Grob JJ et al (2014) Ipilimumab versus placebo after complete resection of stage III melanoma: initial efficacy and safety results from the EORTC 18071 phase III trial. J Clin Oncol 32:5 s(suppl; abstr LBA9008)

    Google Scholar 

  64. Eggermont AM, Chiarion-Sileni V, Grob JJ et al (2015) Adjuvant ipilimumab versus placebo after complete resection of highrisk stage III melanoma (EORTC 18071): a randomised, double-blind, phase 3 trial. Lancet Oncol 16(5):522–30

    Google Scholar 

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Acknowledgments

This work was supported by Award Number P50 CA121973 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

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Correspondence to John M. Kirkwood .

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Davar, D., Kirkwood, J.M. (2016). Adjuvant Therapy of Melanoma. In: Kaufman, H., Mehnert, J. (eds) Melanoma. Cancer Treatment and Research, vol 167. Springer, Cham. https://doi.org/10.1007/978-3-319-22539-5_7

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