Adjuvant therapy for melanoma.
Patients with deep primaries (> or = 4 mm) or regional lymph node involvement often require adjuvant therapy in addition to surgery to successfully treat melanoma. Various adjuvant strategies are reviewed. Randomized trials of IFN-alpha adjuvant therapy have demonstrated statistically significant improvements in disease-free and overall survival rates, leading to approval by the United States Food and Drug Administration of the use of 1 year of intensive IFN-alpha2b following surgical resection of high-risk disease. A study comparing high-dose IFN with the ganglioside vaccine GMK was terminated early when the Data Safety Monitoring Committee concluded that the high-dose IFN treatment arm was associated with highly significantly improved relapse-free and overall survival. Studies of IFN-alpha in stage I and II melanoma are reviewed. Dose and schedule issues in the use of IFN-alpha are addressed. In addition to adjuvant therapy with IFN-alpha, various other treatment strategies appear promising. Adjuvant vaccine therapy may be useful for treatment of cutaneous melanoma. Polyvalent melanoma vaccines are discussed as a potential adjuvant therapy. Finally, nonrandomized preliminary studies suggest that postoperative radiation to the neck or axilla after radical lymph node dissection may decrease regional recurrence rates in node-positive patients, supporting the selective use of radiation therapy for melanoma.
Sondak
V K
VK
Division of Surgical Oncology, University of Michigan Medical School, Ann Arbor, USA.
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019496:Cancer Vaccines / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007371:Interferon-gamma / Q000627:therapeutic use; D008545:Melanoma / Q000188:drug therapy* / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D016898:Interferon-alpha; D007371:Interferon-gamma