Adjuvant Therapy for Locally Advanced Melanoma

Source: OncLive, September 2019

Sanjiv S. Agarwala, MD: In terms of adjuvant therapy, we’ve talked a lot about the stage III patients. I want to just delve a little bit into the stage IIIa population, which has evolved recently, right? There’s a small, very small amount of melanoma in 1 lymph-node positive, no…mapping done anymore. Dr Schadendorf, let’s start with you. What is your cutoff, if any, for that lymph node that’s positive for a IIIa patient. AJCC8 [American Joint Committee on Cancer Cancer Staging Manual 8th edition] gives them a 90% survival at 10 years. It’s a very high number.

Dirk Schadendorf, MD, PhD: I believe that the AJCC survival curves we are seeing, not the correct numbers. I mean, there are several centers actually that have reanalyzed their databases, including our database. We analyze 2000 patients, and the 10-year survival is in stage IIIa patients without any kind of 75%. With a 75% chance to die within 10 years, I think it’s a good reason to offer these patients treatment.

Caroline Robert, MD, PhD: 25%.

Dirk Schadendorf, MD, PhD: Twenty-five percent death rate. At 12%, I would be more reluctant, and age and other factors would also play into that decision-making process. Another, so we would treat a patient with stage IIIa independent on any tumor load in the sentinel node.
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