Adjuvant treatment of cutaneous melanoma : indications and alternatives. Tratamiento adyuvante de melanoma cutáneo : indicaciones y alternativas.

Abstract

Surgery is the main treatment modality for non-metastatic melanoma, and resectable metastatic melanoma. However, 10-year disease-free survival (DFS) after surgery for stage III melanoma ranges from 24% to 88%. Several studies have explored the option of adjuvant therapy, including interferon, immunotherapy, and targeted therapy with anti-BRAF / MEK agents in patients with a BRAF mutation. This article reviews the relevant evidence for adjuvant systemic therapies in cutaneous melanoma. High-dose interferon alpha demonstrated modest benefit in SLE, at the expense of high toxicity, and is no longer used in Colombia. Similarly, immunotherapy with ipilimumab is less effective and more toxic than immunotherapy with nivolumab, an anti-programmed death 1 (anti-PD1) monoclonal antibody in a study that included patients with stage IIIB-IV after complete resection. Pembrolizumab, another anti-PD1, is also effective after resection in stage III melanoma (with nodal tumor deposit > 1 mm). For patients with a BRAF V600 mutation, oral targeted therapy with dabrafenib plus trametinib for one year is an alternative for stage III (with nodal tumor deposit > 1 mm). The treatment selection to be administered depends on clinical factors such as stage and molecular. In general, some form of adjuvant anti-PD1 therapy or targeted therapy is recommended in resected melanoma at high risk of relapse.