European approach to adjuvant treatment of intermediate- and high-risk malignant melanoma.
Adjuvant therapies for patients with melanoma at high risk of relapse whether local, such as excision margins, elective regional lymph node dissection (ELND), and prophylactic isolated limb perfusion (ILP), or systemic, such as chemotherapy, immunotherapy, immunochemotherapy, or vaccination therapy, have little or no impact on survival when evaluated in randomized trials. The European approach to the treatment of each stage of malignant melanoma is characterized by thoughtful caution with particular attention being paid to the avoidance of unwarranted mutilation or toxicity because phase 3 studies have failed to demonstrate unequivocal benefits for a more aggressive approach. In Europe, there is no standard adjuvant systemic therapy; high-dose interferon (IFN) is used sporadically in individual patients by some physicians, but there is little enthusiasm for adopting this regimen as the standard of care because of its high toxicity profile and the lack of a clear beneficial impact on long-term survival. Less toxic lower-dose maintenance IFN regimens, antiangiogenic agents, and vaccine therapies are currently being explored.
Eggermont
Alexander M M
AM
Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Gore
Martin
M
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019496:Cancer Vaccines / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D017558:Elective Surgical Procedures; D005060:Europe; D006801:Humans; D007167:Immunotherapy; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D008197:Lymph Node Excision; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D014611:Vaccination
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D016898:Interferon-alpha