The Melanoma Letter, now in its 37th year of publication, is a quarterly newsletter featuring articles by prominent medical authorities. It is designed to keep clinicians, scientists and other health professionals up-to-date on advances in diagnosis and treatment, as well as basic research breakthroughs.
In This Issue
In this issue of The Melanoma Letter, Jeffrey Zhao and Drs. Galvez and Sosman describe the evolution of these exciting developments in melanoma adjuvant therapy and detail the benefits and limitations of the new and impending treatments. In a second article, they address an even newer development, neoadjuvant therapy, treating stage IIIA–C patients before they have been operated on, to reduce tumor size and prime the immune system in the presence of tumor to improve survival.
While these developments in adjuvant therapy are very promising, in the absence of mature data on the long-term benefits for patients with stages IIIA–C it could be argued, at least for stage IIIA patients, that instead of subjecting all these patients to potential toxicity from adjuvant or neoadjuvant therapy, it might be just as well to hold off using these drugs until patients show evidence of recurrence or further metastatic spread. Therapy would thus be initiated only for the relatively low percentage of stage IIIA patients who manifest disease progression, sparing the rest of patients from unnecessary treatments and side effects. (In the eighth edition AJCC staging guidelines, five-year melanoma-specific survival rates are predicted to be 93 percent for stage IIIA.) However, we suspect that significant survival trends will be emerging in both adjuvant and neoadjuvant settings, and the next few years will likely inform us better as to which stage III, and perhaps even stage II, patients will benefit most from these therapies.